"Exercise… to Me, It's Freedom": Motivation, Support, and Self-Management to Keep Physically Active with Parkinson's Disease: A Qualitative Study

The benefits of exercise have been widely explored among people with Parkinson's (PwP). Exercise can improve non-motor (fatigue, pain, sleep, etc.) and motor features (balance, muscle strength, gait speed, etc.), maintain function, as well as prevent disease progression. Although the benefits are well known, PwP continue to show difficulty adhering to physical activity and exercise. This study aims to explore motivation to exercise, support, and self-management needs among people with Parkinson's, their family members, and physiotherapists. Purposeful and maximum-variation sampling methods (age, sex, geographical setting, and disease severity) were employed. PwP and family members were recruited through physiotherapy services and local support groups. Twelve semi-structured interviews with PwP and two group interviews, one with family members (n = 4) and one with physiotherapists (n = 5), were conducted. Interview guides were informed by patient-public input and a recent systematic review. Interviews were recorded, transcribed, and analysed using thematic analysis informed by the Grounded Theory methodology. Four common themes emerged: (1) The value of an intrinsic connection with exercise, for which there are challenges. A greater connection to exercise led to long-term adherence. (2) Adapting exercise to the needs and preferences of a person is essential. Preferred exercises and environments were mixed, with differences emerging between sexes. (3) Physiotherapists' aim to only maintain physical function led to frustration. Limited self-management opportunities, stigma, and dehumanisation were discussed. (4) Non-motor symptoms, stigma, fear, and determination as well as apathy, pain, and low mood were discussed. Exercise provided physical, emotional, and social rewards. Supports are necessary; however, challenges arise when PwP's motivations are mismatched to family members' and physiotherapists' goals. Co-created goals, tailored to their preferences, and exercise plans with supported self-management are recommended.

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

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

Social Interaction and Physical Activity Among Rural Older Adults: A Scoping Review

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults.

Promoting Strength Training Among Baby Boomers: Message Framing Effects on Motivation and Behavior

BACKGROUND

Regular participation in strength training significantly enhances older adults' physical and functional health, yet only 14% of adults over age 50 report engaging in strength training at least twice per week. Exercise messages about why and how older adults should engage in strength training could influence their perceptions of and participation in the behavior. This study was designed to promote strength training among adults aged 50-70 and to determine whether the message frame accompanying a brief workout would have an impact on participants' motivation, self-efficacy, and/or physical activity behavior.

METHODS

Participants (N = 308) were randomly assigned to one of four message conditions: Easy Intrinsic, Hard Intrinsic, Easy Extrinsic, or Hard Extrinsic. Immediately after completing baseline measures of motivation and physical activity, participants received the recommended strength training workout and corresponding motivational message. They completed follow-up measures of motivation and physical activity 2 weeks later.

RESULTS

Controlled regulation was higher at follow-up among participants exposed to an extrinsic message relative to an intrinsic message (F(3,208) = 3.08, p = .03). Strength training (Z = - 5.95, p < .001) and moderate physical activity (Z = - 3.23, p = .001) increased among participants not engaging in regular strength training at baseline.

CONCLUSIONS

These results suggest message framing may have a short-term impact on Baby Boomers' physical activity motivation, such that emphasizing extrinsic goals (i.e., weight loss and appearance) may contribute to controlled motivation. However, repeated measurements are needed to determine the longer-term maintenance and influence of these effects.

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.

Factors influencing physical activity participation among older people with low activity levels

Despite the well-documented health benefits of physical activity in older adults, participation levels remain low. With rapid global population ageing, intensive efforts are needed to encourage higher levels of participation to ameliorate the negative effects of physical inactivity for older individuals and society as a whole. The aim of this qualitative study was to inform future physical activity promotion interventions by examining factors contributing to low activity levels among older people undertaking less than half the recommended level of moderate-to-vigorous physical activity (MVPA). Semi-structured interviews were conducted with 102 (65% female) community-dwelling Western Australians aged 60+ years (mean = 71.52, standard deviation = 6.26) who engaged in ⩽75 minutes of MVPA per week as measured by accelerometers. Several modifiable and unmodifiable barriers were identified, of which poor health featured most prominently. Lifetime physical inactivity, caring duties, low motivation, misperceptions of physical activity and ageing, and a lack of affordable and attractive options were the other barriers identified. The results suggest that strategies are needed to raise awareness of current physical activity guidelines, normalise engagement in MVPA throughout the lifespan, develop initiatives to motivate participation, improve the availability of affordable physical activity programmes that are attractive to this population segment, and facilitate participation among those with intensive caring responsibilities.

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 .

Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study

Background

Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.

Aim

To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.

Methods

Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.

Results

Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.

Conclusion

Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

Factors influencing regular physical exercise among the elderly in residential care facilities in a South African health district

Background

Physical exercise plays an important role in healthy ageing, but the elderly do not engage in it regularly.

Methods

In this cross-sectional study, we sampled 139 residents of residential care facility. A questionnaire was used to obtain information on participants’ demography, health problems, nature, motivators and barriers to exercise. Chi-square test examined the relationship between participants’ characteristics and their engagement in regular exercise.

Results

Of the 139 participants, the majority were females (71.9%), white people (82.7%), aged 70 years or more (70.5%), had at least one health problem (85.6%) and were overweight or obese (60.4%). Approximately 89.2% engaged in some form of physical activities but only 50.3% reported engaging regularly. Participant’s knowledge of the benefits of regular physical activities, opportunities to socialise, encouragement by health care workers and availability of exercise facilities and trainers promote regular physical exercise. Barriers to regular exercise included poor health status, lack of knowledge of the benefits of regular physical activities, lack of opportunities to socialise, lack of encouragement by health care workers and unavailability of exercise facilities and trainers. Factors that predicted exercise were age 60–69 years (p = 0.02), being Afrikaans speaking (p = 0.04) and completing high school (p = 0.03).

Conclusion

A significant proportion of the elderly do not engage in regular physical exercise, and this behaviour is influenced by personal health status and systems-related motivators and barriers.

Experience of sport stacking in Korean older adults

Today sedentary lifestyles are a major public health concern and there are many evidences related to physical inactivity. The well-documented evidence is that regular physical activity is an essential part for improving overall health with advancing aging and the most efficient means playing roles of rehabilitation and prehabilitation. However, there are few activity programs which could motivate older adults to continue and maintain their active lifestyles. The purpose of the current study was to describe experience of sport stacking which applied to Korean older adults in the first time. Eighteen older adults living in the community in Seoul which was the capital and largest metropolis of the Republic of Korea participated in the study. A qualitative interview and a survey were conducted and data were analyzed by interpretive content analysis. Individual, semistructured, face-to-face interviews were recorded, transcribed, condensed and coded to find themes. The main themes were identified regarding older adults' experience of sport stacking: enjoyment of sport stacking, attitudes toward sport stacking as a physical activity program, and benefits from sport stacking. In conclusions, Korean older adults had positive experience of sport stacking and it was necessary for developing strategies to spread it as the physical activity program for older persons in Korea to improve their health and quality of life.

Perceptions of physical activity among elderly residents and professionals in assisted living facilities

Background

Physical activity is often described as being important for people of all ages, but what different people mean when they talk about physical activity is unclear.

Method

A phenomenographic method was used to analyze how 13 older people and 17 professionals answer the question, “If I say physical activity, what does the concept mean to you?” as part of semi-structured interviews conducted in four assisted living facilities in two different municipalities.

Results

We identified a number of different perceptions of physical activity, with the older people and professionals having different responses. Elderly and professionals alike, define physical activity as a requirement for life and as an opportunity to maintain the body although they define the concepts in different ways. Elderly define the concept as a way to create meaning and the professionals have the attitude that the concept means everyday activities.

Conclusion

The concept of physical activity may be defined in many different ways. This study has shown that elderly and professionals do not define physical activity in the same way. Therefore, professionals need to be aware of these differences when talking with elderly about individual needs in everyday life.

Physical Activity Perceptions and Influences among Older Adults in Rural Nova Scotia

This study identified factors that influenced physical activity (PA) participation among older adults from rural settings in Nova Scotia Canada and explored how the rural context may influence PA participation and promotion. Data were collected via individual semistructured interviews with 20 older adults (Mage = 77.5 years) from rural areas of Cape Breton and subjected to thematic analysis procedures (Braun & Clarke, 2006). Four themes representing factors that influence the prioritization of PA were identified: (1) historical context of activity, work, and productivity; (2) already busy with day-to-day activities; (3) being/staying on the go; and (4) cautionary approach. These findings suggest that PA promotion should be contextually salient, and highlight the need for a shared understanding between rural older adults and PA promoters regarding what constitutes being "physically active". Effective promotion of PA among rural older adults may require a shift away from contemporary methods of PA promotion.

An In-Depth Examination of Perceptions of Physical Activity in Regularly Active and Insufficiently Active Older African American Women: A Participatory Approach

Despite considerable research and programmatic efforts to alleviate racial/ethnic disparities in physical activity (PA), disparities in PA among older minorities and major racial ethnic groups persist. This study explored perceptions of PA among regularly active (RA) and insufficiently active (IA) older African American women (AAW) and the factors that influence (positively and negatively) their physical participation in their socio-cultural environment. A total of 20 AAW aged 60 to 80 years participated in a cross-sectional mixed-methods study (i.e., qualitative and quantitative) employing participatory research approaches (i.e., photoelicitation) along with an objective assessment of PA. Nine women were considered RA and 11 IA according to current PA recommendations. RA and IA women held two major beliefs about the nature of PA (i.e., PA as a broadly defined construct that goes beyond traditional exercise routines; and PA and exercise are synonymous and can be used interchangeably) and had a good understanding of its benefits. Participants in both groups did not know about the importance of PA intensity for health benefits. Barriers and facilitator of PA were found to be similar among RA and IA participants. Special attention should be paid to providing access to no or low cost opportunities for PA participation in safe environments.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Maintenance of physical function in frail older adults

Inactivity leads to frailty and loss of function for older adults. Most older adults are sedentary. Participating in a regular routine of physical activity is recommended for maintaining physical function required to sustain quality of life and independence for older adults. Annual screening for level of physical activity is required to determine changes from year to year. Research shows older adults are more likely to initiate a regular routine of physical activity when a health care provider writes a prescription for physical activity including the type, frequency, and specific duration of physical activity sessions.

Barriers and motivators to exercise for older adults: a focus on those living in rural and remote areas of Australia

To identify the barriers and facilitators for exercise in older adults (50 years or over) specific to those living in rural and remote areas in Australia and to identify how this relates to falls prevention exercise programs in these areas. Literature review. Search of the databases of Medline, Scopus and Social Sciences Citation Index. Rural and remote areas. Searching identified 56 articles relating to barriers or facilitators to exercise in older adults in general, of which 25 are discussed in the article. Five of these articles specifically related to rural and remote areas, of which all were from studies in the United States. No literature specifically relating to rural and remote Australia was identified. Therefore, articles included in the final review were from three different domains - world literature (excluding those specific to rural and remote areas of Australia), rural and remote literature (note not Australian), and Australian literature to enable a comparison between the different populations to occur. There are similarities and differences between the barriers and facilitators in various populations, and no one factor alone will enable exercise in older adults. Research needs to be conducted on the barriers and facilitators to exercise in older adults living in rural and remote areas in Australia. Falls prevention exercise programs need to be tailored to suit the unique needs of the rural and remote older population.

Physical Activity in People Age 80 Years and Older as a Means of Counteracting Disability, Balanced in Relation to Frailty

The aim of this study was to describe experiences of physical activity, perceived meaning, and the importance of and motives and barriers for participation in physical activity in people 80 years of age and older. A qualitative design with focus-group methodology was used. The sample consisted of 20 community-living people age 80–91 yr. Data analyses revealed 4 themes: physical activity as a part of everything else in life, joie de vivre, fear of disease and dependence, and perceptions of frailty. Our results suggest that physical activity was not seen as a separate activity but rather as a part of activities often rated as more important than the physical activity itself. Thus, when designing physical activity interventions for elderly people, health care providers should consider including time for social interaction and possibilities to be outdoors. Moreover, assessment of physical activity levels among elderly people should include the physical activity in everyday activities.

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.

Time trends in leisure time physical activity and physical fitness in elderly people: 20 year follow-up of the Spanish population national health survey (1987-2006)

BACKGROUND

To estimate trends in leisure time physical activity and physical fitness between 1987-2006 in older Spanish people.

METHODS

We analyzed data collected from the Spanish National Health Surveys conducted in 1987 (n = 29,647), 1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The number of subjects aged ≥ 65 years included in the current study was 29,263 (1987: n = 4,958-16.7%; 1993: n = 3,751-17.8%; 1995-97: n = 2,229-17.4%; 2001: n = 4,356-20.7%; 2003: 6,134-28.3%; 2006: 7,835-26.5%). Main variables included leisure-time physical activity and physical fitness. We analyzed socio-demographic characteristics, self-rated health status, lifestyle habit and co-morbid conditions using multivariate logistic regression models.

RESULTS

Women exhibited lower prevalence of leisure time physical activity and physical fitness compared to men (P < 0.05). The multivariate analysis for time trends found that practising leisure time physical activity increased from 1987 to 2006 (P < 0.001). Variables associated with a lower likelihood of practicing leisure time physical activity were: age ≥ 80 years old, ≥ 2 co-morbid chronic conditions, and obesity. Variables associated with lower physical fitness included: age ≥ 80 years, worse self rated health; ≥ 2 medications (only for walking), and obesity.

CONCLUSIONS

We found an increase in leisure time physical activity in the older Spanish population. Older age, married status, co-morbid conditions, obesity, and worse self-perceived health status were associated with lower activity. Identification of these factors can help to identify individuals at risk for physical inactivity.