Towards co-designing active ageing strategies: A qualitative study to develop a meaningful physical activity typology for later life

Validity and reliability of the Checklist for Habitual Physical Activity for people 75 years and older in Japan

BACKGROUND

Despite health benefits, many older adults struggle to meet physical activity guidelines, leading to stagnant activity levels. While integrating physical activity into daily routines has been proposed as a promising strategy for older adults, fit-for-purpose measurement tools to assess such routines are lacking. The Checklist for Habitual Physical Activity (CHaPA) was developed based on the positive deviance approach and socio-ecological model to assess daily behaviours encouraging physical activity among adults aged 75 and older. It has been confirmed for its content and face validity. However, to ensure its broader applicability and usefulness, assessing its construct validity and reliability is necessary. Therefore, this study aims to assess the construct validity and reliability of the CHaPA and accordingly update the tool.

METHODS

To validate the construct validity of the CHaPA 22-item version, we conducted item analysis and exploratory and confirmatory factor analyses. We removed inappropriate items based on predefined criteria. Then, we assessed the reliability, internal consistency, test-retest reliability, and measurement errors of the CHaPA final version.

RESULTS

Item analyses and factor analyses resulted in the deletion of 11 items. The results of confirmatory factor analysis validated the CHaPA 11-item version with the three-factor structure based on model fit index with χ2/degree of freedom = 1.25, comparative fit index = 0.965, Tucker-Lewis index = 0.952, and root-mean-square error of approximation = 0.038. Omega coefficient (0.90) showed excellent internal consistency. Intraclass correlation coefficient (ICC) demonstrated good test-retest reliability (ICC (1, 2) = 0.77, 95% CI = 0.34-0.89, standard error of measurement = 1.75).

CONCLUSIONS

We finalised the CHaPA 11-item version as a valid and reliable instrument for assessing daily behaviours conducive to physical activity among individuals aged 75 years and older. We need to examine the methods and effectiveness of disseminating this checklist to ensure its utilisation as a resource for promoting healthy ageing and aiding older adults in maintaining active lifestyles.

Barriers and Facilitators to Participation in Vigorous Lifestyle Physical Activity in Adults Aged 55-75 Years: A Scoping Review

Despite the well-known benefits of physical activity, less than half of adults aged 55-75 years participate in sufficient physical activity. Short bouts of vigorous intermittent lifestyle physical activity (VILPA) accumulated throughout the day can contribute toward the recommended volume of physical activity. A rich characterization of the barriers and facilitators to participation in VILPA is needed to develop targeted interventions. This scoping review aimed to identify barriers and facilitators to participation in different components of VILPA in adults aged 55-75 years, and to map barriers and facilitators to the Theoretical Domains Framework. Within the 18 eligible studies, the most prevalent barriers were related to a person's skills, environmental context, and social influences. Most facilitators were related to a person's goals, social influences, and environmental context. Interventions to promote VILPA should test the effectiveness of behavioral change measures related to the unique barriers and facilitators in this age group.

Understanding social frailty

Social frailty, along with physical and psychological frailties, is one of the components of frailty that has been reported to increase the incidence of adverse health outcomes. Although the prevalence of social frailty is relatively high, consensus on how to define and measure it is insufficient. In considering social frailty, living alone, interaction with neighbors, and social participation are important indicators, and interaction with neighbors and social participation, which are modifiable factors, are important countermeasures. The promotion of these social activities will contribute to extending healthy life expectancy-for example, by promoting physical activity. However, older people's physical and social activities have been severely constrained by the coronavirus pandemic since 2020. In the future, it will be necessary to fully understand the characteristics and significance of social frailty and develop appropriate countermeasures.

The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review

BACKGROUND

Inactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities.

METHODS

Arksey and O'Malley's Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis.

RESULTS

Sixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), 'exergames' (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress.

CONCLUSIONS

Population demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common-even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.

Co-Creation and Co-Production of Health Promoting Activities Addressing Older People-A Scoping Review

The global population is aging and the promotion of health and well-being for this generation is essential. Co-creative and co-productive practices can be solutions to welfare challenges in local policies. Therefore, this scoping review aimed to understand the extent and type of evidence in relation to the co-creation and co-production of health-promoting activities addressing older people aged 60+ years and to examine the influence of co-creative and co-productive activities on health and well-being, including influential factors for co-creation and co-production. We searched for peer-reviewed and grey literature in ten scientific and five non-scientific databases. From the 2648 studies retrieved, 18 articles were included in this review. Then, an inductive thematic content analysis was applied to the analysis. Three categories related to co-creative and co-productive activities emerged: "Social and physical activities", "Development of age-friendly environments", and "Discussions of healthy and active aging". Facilitating factors for co-creation and co-production were related to the planning and structure of the process and recognition of participants' time and resources, while the recruitment of participants and their time and resources were the main barriers. Future studies should target co-creative and co-productive interventions to concrete areas and specific sub-groups and be aware of factors influencing a co-creative or co-productive relationship with older people.

Understanding Physical Activity Differences Among Older Adults: Validating a Proposed Typology of Physical Activity as a Tool to Increase Physical Activity by Older Adults

Objective

Being physically active as one ages benefits both physical and mental health and remains a public health need. A typology to understand older adults’ PA level and intentions can be vital to developing strategies to promote PA.

Methods

The researchers developed a comprehensive interview guide and interviewed adults 50 years and older ( n=232) to test the validity of the four-type typology (1). Frail, (2). Ambivalent, (3). Aspiring, (4). Active).

Results

The Kruskal–Wallis test and the Bonferonni post hoc analysis indicated that there were significant differences between types and for each PA category measured, revealing a continuum of PA levels by type and confirmed the four types within this continuum.

Discussion

The validated typology and the associated tool can be used to identify and implement built environment improvements and interventions aimed to support PA needs of older adults.

Co-Produce, Co-Design, Co-Create, or Co-Construct—Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review

Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.

Premature ageing following allogeneic hematopoietic stem cell transplantation

Survivors of hematopoietic cell transplantation (HCT) have been shown to exhibit both clinical and biological features of accelerated ageing. Most studies used frailty measures, comorbidities for clinical assessment and several biological assessment of premature ageing. However, these tests are less suitable for age determination of individual patients. Recently, DNA methylation has emerged as a novel test to measure cellular age. In the present study, we assessed ageing in a cohort of 26 survivors of allogeneic HCT by frailty tests comprising the handgrip and 6 min walk tests and by biological tests including DNA methylation, telomere length and expression of p16INK^4A and serum levels of IL-6. DNA methylation was evaluated both in blood and buccal epithelial cells. Physiological reserve was markedly reduced in transplant survivors, reflected by 6 min walk test. Increased IL-6 serum levels and p16^ink4A correlated with accelerated ageing. Overall, the measured age of donor blood cells was significantly higher than these blood cells residing in their respective donors, as reflected by DNA methylation and by buccal epithelium methylation status. These clinical and biological observations suggest that allogeneic HCT is associated with accelerated ageing.

Barriers and Motivators of Physical Activity Participation in Middle-aged and Older-adults - A Systematic Review

Identifying the difference in barriers and motivators between middle-age and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on barriers and motivators for physical activity in middle-aged (50-64 years) and older adults (65-70 years). The review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9400 results from seven databases. A total of fifty-five articles meeting the inclusion criteria. Results indicate that barriers are comparable across the two age groups with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement and assistance in managing change were the most identified motivators. Middle-aged identified goals settings, believe that activity will be beneficial and social influences were most important. Findings can be used by professionals to encourage engagement with and adherence to physical activity.

Barriers and facilitators of adherence to a perioperative physical activity intervention for older adults with cancer and their family caregivers

PURPOSE

Perioperative physical activity behavior change in older adults with cancer is complex. Identifying the barriers and facilitators to physical activity before and after surgery can help predict adherence and optimize outcomes. We aimed to determine the barriers and facilitators of adherence to a perioperative physical activity intervention in older adults with lung and gastrointestinal (GI) cancers and their family caregivers (FCGs).

METHODS

A qualitative analysis of physical therapy/occupational therapy (PT/OT) baseline geriatric/functional assessment and intervention sessions notes were undertaken (N = 34 dyads). Written text documents (N = 6 independent PT/OT notes per dyad) were transcribed into a spreadsheet for coding and thematic analysis. Content analysis qualitative approach was used to identify themes and guide data interpretation.

RESULTS

Ten themes for barriers and five themes for facilitators emerged, reflecting barriers to and facilitators of perioperative physical activity adherence. Primary barriers to adherence included comorbid health conditions, physical symptoms, functional limitations, anxiety, other roles and responsibilities, unexpected life events, lack of time and motivation, not accustomed to physical activity, and environment/weather. Facilitators that enabled intervention adherence included physical activity as part of routine, coping strategies, setting goals for motivation, social/family support, and experiencing benefits from walking.

CONCLUSIONS

Barriers and facilitators to a perioperative physical activity is multidimensional, and focused on social-ecological determinants of health behaviors, including intrapersonal, interpersonal, and environmental factors. Perioperative physical activity interventions for older adults with cancer and their FCGs should integrate strategies to promote self-efficacy, support realistic activity goals, enhance motivation, and optimize social support.

A life fulfilled: positively influencing physical activity in older adults - a systematic review and meta-ethnography

BACKGROUND

Increasing physical activity in older adults remains a key public health priority in countries with a high burden of non-communicable disease, yet current interventions have failed to substantially increase population uptake with UK data suggesting that only half of 65-74 year olds report meeting recommended levels. The aim of this study was to conduct a systematic and inductive qualitative synthesis of the large body of qualitative research describing what influences physical activity at this age, and older adults' experiences of physical activity.

METHODS

A qualitative meta-ethnography was chosen as the study design as this inductive approach can provide novel insights and generate new theory about physical activity and ageing. Papers were identified by searching electronic databases and key citations. Peer-reviewed primary qualitative studies and systematic reviews were included if they met the following inclusion criteria: community-dwelling participants aged 60 years or older or in the retirement transition period; reporting on leisure-time physical activity; utilising a rigorous qualitative methodology. A line of argument approach was employed to generate a theory about how older adults think and feel about physical activity.

RESULTS

Thirty-nine papers met the inclusion criteria and were synthesised. The emergent theory suggested transition to older age can challenge people's sense of self and their role in life. Physical activity can help in regaining feelings of purpose, of being needed in collective group activity, and by creating habitual routine and structure to the day. In overcoming real and perceived barriers, and by taking up or sustaining physical activities, older adults can further build self-esteem all of which contributes to a fulfilling older age.

CONCLUSION

Current failures to increase population levels of physical activity in older adults may be explained by an approach overly focused on the health benefits of activity. Insights from this study suggest we need to reframe our approach to consider the wider set of goals and aspirations which are of greater personal importance to older adults, and future interventions should focus on how physical activity can contribute to life satisfaction, sense of purpose, and sense of role fulfilment in older age.

TRIAL REGISTRATION

Registered prospectively on PROSPERO on 29th March 2013: CRD42013003796 .

Towards co-designing active ageing strategies: A qualitative study to develop a meaningful physical activity typology for later life

BACKGROUND

Physical activity levels decline in later life despite the known benefits for physical, cognitive and mental health. Older people find it difficult to meet activity targets; therefore, more realistic and meaningful strategies are needed. We aimed to develop a typology of older people's motivations and lifelong habits of being active as a starting point to co-designing active ageing strategies in a workshop.

METHODS

We conducted semi-structured interviews with 27 participants aged 65-80 in Norfolk, UK, and participant observation with 17 of them. At a workshop with 13 study participants and 6 government and civil society representatives, we invited reflections on preliminary findings.

RESULTS

Three types were developed. "Exercisers" had engaged in sport and exercise throughout their life but experienced physical ill health and limitations as barriers. "Out-and-about-ers" pursued social engagement and a variety of interests but experienced biographical disruption through retirement and loss of companions that limited social activities in later life. A final type characterized people who preferred "sedentary/solitary" activities. A workshop elicited suggestions for new strategies relating to these types that addressed people's specific motivations. An example was to combine social engagement and physical activity in "dog-parent"-walking schemes to link people through shared responsibility for a dog.

CONCLUSIONS

We suggest that these potential strategies map more closely onto the everyday life-worlds in which public health might seek to intervene than common physical activity interventions. Most notably, this means a more differentiated understanding of barriers, and acknowledging that intellectual, social or solitary pursuits can include incidental physical activity.