Adequate physical activity has been shown to benefit older adults by reducing the risks for age-related physical degeneration including osteoporosis, arthritis, cardiovascular disease, diabetes, cancer and a higher likelihood of falling (Tiedemann et al., 2011; Ewald et al., 2009). However, a sedentary lifestyle has increasingly become the norm among older adults. Inadequate physical activity is defined as engaging in moderate-intensity exercise for a duration that is less than the recommended 2.5 hours per week or failing to do moderate exercise for 30 minutes on most days of the week (Jancey et al., 2008; Sims et al., 2010). In Australia about 49-63% of older adults between 60 and 75 years old are sedentary with a third totally inactive (Ewald et al., 2009). Sedentary lifestyle accounts for 7.3-9.3% of the mortality burden among Australian adults and is magnified during older adulthood (Bird et al., 2009).What is also distressing is that only 40% of older Australians report the desire to increase their physical activity (Sims et al., 2010). Clearly, there is an urgent need to promote a more active lifestyle in the older adult population.
Literature shows that individualised interventions and those that aim to overcome barriers are the most effective (Jancey et al., 2008; Bird et al., 2009). It was also found that physical and social environments are significant influences in the decision to exercise. For instance, geographical location, access to places where older adults can do physical activity and the quality of social interaction fostered by programmes in the community play a role in strengthening a personal commitment to become more active (Jancey et al., 2008; Bird et al., 2009). Thus, many of the interventions previously implemented were in a group setting and increased access to resources that enable greater physical activity with the end goal of maintaining the desired behaviors in the long term. Regarding the design of active lifestyle programmes, studies recommend that the teaching methods, communication styles and motivational strategies employed should fit the needs, circumstances and preferences of the older adult. Educational attainment, culture and socioeconomic status are other individual attributes that also affect behaviors related to exercise (Bird et al., 2009).
Addressing barriers requires studying the hindrances experienced by older Australians. Bird et al. (2009) conducted a survey of 363 older adults representing seven cultural minority groups and results showed that poor health status, bad weather, low energy levels, fatigue, fear of injury, lack of motivation, no time, no access to safe places for exercise, nobody to exercise together with, body image issues and an aversion to exercise were the most common barriers. Post-survey interviews also shed light on culturally-defined barriers such as gender roles, acceptable forms of exercise and the social nature of physical activity (Bird et al., 2009). Using a similar method, Macniven et al. (2013) investigated what 2,225 older Australians perceived were barriers and enablers to greater physical activity. The study found that illness and having nobody to share activities with were significantly associated with the inability to meet physical activity recommendations (Macniven et al., 2013). This is while costs and time as enablers were linked with a higher probability of meeting recommendations.
Besides knowing the barriers, effectively reducing the prevalence of sedentary lifestyles necessitates the use of research evidence. Sims et al. (2010) performed a review of literature on physical activity guidelines specifically developed for older adults, ranked the evidence and obtained expert opinion to generate five recommendations. First, all older adults regardless of health condition, weight, age and functional capacity must be encouraged to exercise as much as they are physically able. Second, they must be encouraged to be active on a daily basis through a variety of activities promoting balance, strength, fitness and flexibility (Sims et al., 2010). Third, the need to perform 30-minute moderate-intensity activities of moderate intensity daily or on most days has to be emphasised. Fourth, for older adults who were previously sedentary or are trying out other types of activities, it is best to start at an easy level and then progressively increase the duration, frequency and intensity. The last recommendation urges older adults to maintain their current level of activity for as long as they are able and applies to older adults who have always been physically active.
An example of an individualised and group-based intervention utilising guidelines was developed by Jancey et al. (2008). The overall goal was to increase and sustain physical activity among older Australians through a community-based walking programme. It aimed to address the older adult’s beliefs and attitudes in order to engender participation in walking and related exercises. Increasing self-efficacy or the participant’s self-confidence that he can successfully take part in the programme was also another objective. Based on a social cognitive model, the programme took into consideration predisposing factors or those that motivate the older adult to become active (Jancey et al., 2008). This included increasing the older adult’s knowledge and shaping beliefs and attitudes through education. Meanwhile, enabling factors were those that helped produce the desired behavior and included skills, financial resources and access to programmes. A sample of 260 older adults 65 years and older were invited to join small walking groups at no cost for twice-a-week structured activities that lasted for 26 weeks (Jancey et al., 2008).
Many of the barriers later validated by more recent studies were addressed by the programme. For instance, participant convenience, safety and preferences to the location of exercises were factored in decisions. The group setting facilitated social interaction, network-building and reinforcement among members. Trained walk leaders provided education, assessed each participant’s capacity for exercise, individualised plans to gradually increase the duration and intensity of activity as well as improve balance, endurance and flexibility (Jancey et al., 2008). Psychomotor skills were taught and walk leaders were empathic and supportive providing constant feedback and motivation to programme participants. Maintaining open communication was meant to address concerns, issues or problems. About 65% of the sample finished the programme, an acceptable rate compared to other studies. About 80% expressed the desire to continue exercising and those who were interested to become walk leaders were encouraged to do so (Jancey et al., 2008). Among those who finished, the average weekly duration of walking fulfilled recommendations.
In summary, the health needs of an increasing older adult population in Australia deserve adequate public health focus especially with the anticipated growth of this population. Statistics show a high prevalence of sedentary lifestyle among older Australians which has negative impacts on health. To reduce the burden of disease and improve quality of life, there is an urgent need to promote physical activity. The literature clearly points to selecting the most appropriate model to guide programme design while evidence-based recommendations should guide content. Implementation should be individualised to consider ability, needs, barriers, facilitators and other attributes associated with older adults. The physical and social environment including culture should be factored in as well. What remains to be answered is “What are other successful physical activity promotion programmes that used the same or different models?” Knowing the types of interventions available and their strengths and weaknesses will increase the options especially when working with different subpopulations of older adults such as women, cultural minorities or the chronically ill who may have different needs.
References
Bird, S., Radermachers, H., Feldman, S., Sims, J., Kurowski, W., Browning, C., & Thomas, S. (2009). Factors influencing the physical activity levels of older people from culturally-diverse communities: an Australian experience. Aging and Society, 29(1), 1275-1294.
Ewald, B., Duke, J., Thakkinstian, A., Attia, J., & Smith, W. (2009). Physical activity of older Australians measured by pedometry. Australasian Journal on Ageing 28(3), 127-133.
Jancey, J.M., Clarke, A., Howat, P.A., Lee, A.H., Shilton, T., & Fisher, J. (2008). A physical activity program to mobilize older people: A practical and sustainable approach. The Gerontologist, 48(2), 251-257.
Macniven, R., Pye, V., Merom, D., Milat, A., Monger, C., Bauman, A., & van der Ploeg, H. (2013). Barriers and enablers to physical activity among older Australians who think they are insufficiently active. Journal of Science and Medicine in Sport, 15(S1), S45-S46.
Sims, J. (2012). Advancing physical activity in older Australians: Missed opportunities? Australasian Journal on Ageing, 31(4), 206-207.
Sims, J., Hill, K., Hunt, S., & Haralambous, B. (2010). Physical activity recommendations for older Australians. Australasian Journal of Ageing, 29(2), 81-87.
Tiedemann, A., Sherrington, C., Close, J.C.T., & Lord, S.R. (2011). Exercise and Sports Science Australia position statement on exercise and falls prevention in older people. Journal of Science and Medicine in Sport, 14(1), 489-495.
