Barriers and facilitators to exercise adherence in community-dwelling older adults: A mixed-methods systematic review using the COM-B model and Theoretical Domains Framework

BACKGROUND

Although the health benefits of exercise for older adults are widely recognized, physical inactivity is still common among older adults. Further clarification of the factors affecting exercise adherence is needed to develop more effective exercise interventions in community-dwelling older adults.

OBJECTIVE

The purposes of this study were to identify (1) barriers and facilitators of exercise adherence in community-dwelling older adults and (2) behavior change techniques (BCTs) and implementation strategies that are potentially effective in improving adherence.

METHODS

A total of eight databases were searched: PubMed, Web of Science, EMBASE, CENTRAL, PsycINFO, SPORTDiscus, MEDLINE, and Scopus. Studies published from database inception to April 2023 were searched. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). The Capabilities, Opportunities, Motivations, Behavior (COM-B) model and the Theoretical Domain Framework (TDF) were used to identify potential barriers and facilitators. The BCTs were used to identify potential intervention implementation strategies.

RESULTS

A total of 64 studies were included, including 30 qualitative studies, 12 randomized controlled trials, 12 mixed methods studies, 6 quantitative descriptive studies, and 5 non-randomized trials. 54 factors influencing adherence and 38 potentially effective BCTs were identified from the included studies. The 38 BCTs were further categorized into 8 areas of implementation strategies (tailored exercise program, appropriate exercise environment, multidimensional social support, monitoring and feedback, managing emotional experiences and issues, participants education, enhancing self-efficacy, and exerting participants' autonomy).

CONCLUSION

This study identified 54 influential factors affecting exercise adherence and identified 8 areas of intervention strategies (containing 38 BCTs). Further refinement, evaluation, and validation of these factors and strategies are needed in future studies.

What Do We Know About the Value of Sport for Older Adults? A Scoping Review

Issues relating to older adults in sport are ongoing topics of interest among sport scientists; however, our knowledge on how older athletes have been studied is incomplete, which has implications for understanding the comprehensiveness of this evidence base. This scoping review aimed to provide an overview of how sport and older adults have been studied since the first World Masters Games. Data on research topics, research methods, sport-specific information, and demographic information on older athletes were collected and reviewed. Results suggest older athletes who are White, male, and competitive athletes have largely been the focus of research. In addition, results highlight an alarming number of unreported data related to the demographics of athlete samples. As a result, the well-documented benefits of sport may reflect a homogenous group of older adults, limiting our overall understanding of aging and sport and the value of this research for developing evidence-informed policy.

Psychosocial Aspects of Participation in Competitive Sports Among Older Athletes: A Scoping Review

BACKGROUND AND OBJECTIVES

In the last decade, sport has been considered a tool in active aging to maintain physical fitness, improve mental well-being, and form social relationships among older people. However, a thorough psychosocial understanding of the phenomenon of older athletes competing in sports events is lacking. Most research has focused on competitive sports participation in the young population. This study analyzes the general state of knowledge of competitive sports participation among athletes aged 50 years and older from a psychosocial perspective.

RESEARCH DESIGN AND METHODS

We followed the 5-step process outlined by Arksey and O'Malley. After the search in 4 electronic databases, 69 peer-reviewed articles met the inclusion criteria.

RESULTS

The findings indicate that psychosocial research into older people's participation in competitive sports has grown moderately in the last decade. While intrapersonal and interpersonal aspects have dominated the academic psychosocial discourse on older athletes' competitive sports participation, aspects related to the environment/community and policy have largely been overlooked.

DISCUSSION AND IMPLICATIONS

We identified several critical gaps in the literature, classified into conceptual (e.g., lesser attention to personality, emotional, and cognitive aspects), methodological (e.g., longitudinal studies almost absent), and diverse aspects (e.g., focus on a wide indiscriminate age range; few comparisons between types of sports; underrepresentation of some nation or world regions as well as few cross-national comparative studies). These research gaps hint at opportunities that future research on older people's participation in competitive sports should address.

How Heavy Lifting Lightens Our Lives: Content Analysis of Perceived Outcomes of Masters Weightlifting

Although the benefits of sport participation for older adults has been well-documented, the traditionally masculine sport of weightlifting has only recently become popular among older women, who now participate at rates comparable to men in the United States. This study describes the self-reported effects of participating in Masters-level Olympic weightlifting on other aspects of life. Contrasting with previous studies of Masters athletes in other sports, the gender balance and broad age range of our sample allowed us to explore whether the self-reported impact of sport on older adults was similar or different across age groups (35–44, 45–59, 60, and older) for both men and women. A total of 352 (191 women, 159 men, 2 other) who completed a survey of Masters lifters registered with the United States national organization (USAW) responded to an open-ended question about how weightlifting has affected other aspects of their life. Across gender and age categories, responses indicated that weightlifting has a positive impact on physical health (strength, mobility, fitness) and on psychological (mental health benefits, stress reduction) and social aspects such as community connections. Female lifters mentioned psychological benefits such as increased confidence and help with stress and depression more commonly than male lifters; older lifters were more likely than middle-aged lifters to mention physical health benefits. Competition was a prominent theme across genders and age groups. The themes mentioned by participants are consistent with previous literature on sports that are less strongly gender-typed than weightlifting.

For the Love of the Game: An Exploration of the Experiences and Psychosocial Development of Women 70 Years of Age and Older Who Play Volleyball

There is much to learn about the lived experience of sport participation in later life for older women. This qualitative study explored the experiences of 18 women volleyball players, ages 70 years and older. Four themes emerged from an inductive analysis of in-depth, semistructured interviews: (a) seeking and enjoying optimal challenge, (b) demonstrating physical competence through skill mastery, (c) commitment to continue playing while navigating declining competence, and (d) connection with teammates and positive reinforcement. Following the inductive analysis, the themes were analyzed using personal assets frameworks as lenses through which to further understand how these women's psychosocial development through sport compared with youth and Masters sport. Challenge, competence, connection, and commitment to continue were salient personal assets identified for these women. Researchers should continue to explore how positive sport development across the lifespan can be both universal and nuanced for diverse cohorts of athletes.

"Being" an Older Adult Skier: The Phenomenology of Masters Alpine Ski Racers

This research examined the lived experience of older adult Alpine skiers in their continued participation in competitive ski racing. The aim was to gain an understanding of the meaning of the experiences for older adults as they continued to compete in Alpine ski racing. Masters skiers between the ages of 69 and 82 years participated in individual interviews. Data collection and analysis were iterative processes informed by phenomenological methods and visual mind mapping. The overarching theme identified in participants' accounts was the significance of the identity of "Being" a Ski Racer. Supporting subthemes were Enjoying the Feeling of Ski Racing, Adapting in the Sport, and Skiing as a Lifestyle. These insights offer the opportunity to encourage and support the holistic experiences of older adults who maintain their athletic identity as they age. This research highlights how inclusion of older adults' stories may foster critical reflexivity and challenge assumptions about aging.

Physical Activity and Aging: Exploring Motivations of Masters Swimmers

Physical activity benefits the health of older adults (e.g., lowering risk of cardiovascular disease, depression, dementia, and falls). However, less than one in four Americans meets guidelines for physical activity and inactivity increases with age. Masters athletes are exemplary because of their remarkable physical functioning. Swimming is a global, fast-growing sport in Masters athletics. This qualitative study explored motivations and barriers of 18 older adult members of a Masters swim club in Southern California. Guided by a primary research question: Why do Masters swimmers choose swim late in life, when most of their age cohort are becoming less physically active, semi-structured interviews delved into the lived experiences of the participants, and solicited peer feedback. Four main themes emerged: (1) I Just Love the Sensation of Being in the Water, (2) Tell Your Body What to Do Instead of the Other Way Around, (3) Make a Commitment to Your Friends That You're Going to be There, and (4) I've Never Gone This Long in My Life Without Swimming. Participants expressed longing and regret that they could not swim due to COVID risk and safety guidelines. These findings can be used to design community programs to promote lifelong physical activity participation.

Reasons why older adults play sport: A systematic review

BACKGROUND

Despite the known contribution of sport to health and well-being, sport participation declines in older age. However, for some people, sport continues to play an important role in older age and may contribute to improved health and well-being in older years. Although the health-related benefits of participating in sport are commonly reported, the reasons why some older adults continue to play sport are not well understood. This systematic review aimed to (1) identify studies from the literature that evaluated the reasons why older adults (aged 55 years and older) participate in sport and (2) synthesize and discuss the reasons for their participation reported in the literature.

METHODS

Searches of the electronic databases Embase, Medline, PsycInfo, PubMed, and SPORTDiscus were performed. Studies were included that evaluated reasons for sport participation in adults aged 55 years and older because this is the age at which sport participation has been reported to begin declining. The studies included in this review used qualitative, quantitative, or mixed methods designs, were peer reviewed, and were published in the English language before the search date (20 January 2019).

RESULTS

A total of 1732 studies were identified. After exclusions, 30 studies were included in the review (16 qualitative, 10 quantitative, and 4 mixed methods). The review presents several features and findings from the studies, including a description and systematization of the reasons for participating in sport and the main reasons that participants gave for participating in sport (maintaining health, feeling and being part of a community, and taking advantage of opportunities to develop relationships). Other reasons included competing and attaining a feeling of achievement, taking advantage of opportunities for travel, and being part of a team. Sport was identified as contributing to the overall experience of successful ageing. There were few comparative differences for participating in sport, and there were only small differences between genders for the reasons given for participation. Generally, the quality of the studies was good; however, mixed methods studies lacked appropriate data analysis procedures.

CONCLUSION

Older adults play sport for a range of health-related and social reasons that can contribute to the experience of successful ageing. Strategies to increase sport participation by older adults should focus on promoting these aspects.

Ageism in the Fitness and Health Industry: A Review of the Literature

This review aims to understand how age-related stereotypes against older adults' physical capabilities influence their ability to engage in regular physical activity. The authors wanted to know how people construe ageism in the fitness and health arena, how ageism manifests in this field, and how ageism influences older adults' learning and practicing physical activity. Data was extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Twenty-two empirical studies met the selection criteria. The findings revealed that the attributes of ageism fell into either self-imposed or other-directed ageism categories and manifested as implicit or explicit ageism. The study also identified the following four themes: (a) perceptions of aging and exercise, (b) exercise motivation, (c) opportunities for older adults, and (d) ambiguous positionality as older exercisers. The research provides evidence for the existence of ageism against older exercisers. Further research considering the implication of ageism within the exercising industry is necessary.

Why Do Older Adults Play Golf? An Evaluation of Factors Related to Golf Participation by Older Adults

Golf is a popular sport for older adults, and is therefore an important source of physical activity. This study investigated the reasons for golf participation in an older population using the Golf Participation Questionnaire for Older Adults. The participants (N = 3,262, 82.5% male) completed the questionnaire online. The most important reasons for participation were fun, a pleasant playing environment, and competition, with reasons related to health being relatively less important. The female participants rated fun, a pleasant playing environment, and a feeling that participation made them part of a community as more important reasons for participating than males. Although health-related factors were identified as important reasons for golf participation in older adults, non-health-related factors were also more important. Strategies to promote golf participation by older adults, as a means of increasing physical activity, should emphasize aspects related to fun, a pleasant playing environment, and engagement in competition.

Psychological and social outcomes of sport participation for older adults: a systematic review

Sport participation is well known to promote health outcomes for children and adolescents. Nevertheless, there is insufficient evidence about the psychological and social outcomes of sport participation for older adults. This article provides the results of a systematic review of the psychological and social outcomes of sport participation for older adults. A systematic review of seven electronic databases was conducted and a total of 21 studies published that attended to psychological and/or social health benefits from sport participation of older adults (50 years old and over) were included. The outcomes of older adults’ sport participation included life satisfaction, depression, anxiety, stress, mood state, hedonistic values, socialisation, competition, and personal psychological outcomes such as personal empowerment, self-confidence, self-esteem and resistance to the negative view of ageing. Future studies are needed to conceptualise and operationalise the different levels of involvement of sport participation.

A Life Course Examination of Women's Team Sport Participation in Late Adulthood

This study contributes to the fields of aging and physical activity by applying the key principles of the life course perspective to investigate women's team sport participation experience in late adulthood. Through focus groups, data were collected from six competitive softball teams of women (N = 64) ranging from 55 to 79 years old. Data were audio recorded, transcribed verbatim, and analyzed for themes related to the life course principles of historical context and place, social embeddedness, agency, as well as trajectories and timing. A key study finding was that the women experienced cultural lag and age-related barriers to resources when playing competitive softball in late adulthood. In addition, the network of shared relationships occupied by these women had both positive and negative influences on their participation in competitive sports. Study findings can help inform services and programs at the local community level aimed at enhancing women's physical activity and health in late adulthood.

The social and psychological health outcomes of team sport participation in adults: An integrative review of research

Aim: The aim of this article was to review the international scientific research literature about the social and psychological health outcomes associated with participation in team sport and to synthesise the key issues about team sport as a health-promoting activity. Methods: The methodological framework guiding the review process is the integrative research review. A search of 10 key electronic databases was conducted to identify both quantitative and qualitative studies addressing the social and/or psychological health outcomes from participation in a team sport. A total of 6,097 publications were identified and 17 studies met the inclusion criteria. Results: A wide range of different positive social, psychological, and psychosocial health outcomes associated with team sport participation were identified in the studies, with emotional social support, sense of belonging, higher self-esteem, social network, and social interaction being the most frequently reported health benefits. In addition, three key issues influencing the psychological and social health outcomes of team sport participation as a health-promoting activity were identified: (1) team sport versus individual sport, (2) competitive versus non-competitive structure, and (3) commitment and continuation. Conclusions: There is consistent evidence that participation in a team sport is associated with improved social and psychological health independent of the type of team sport, age, somatic, or mental health problems. The findings indicate that team sport could be more efficient in promoting health and ensuring exercise participation and continuation than individual sport. However, when utilising team sports for health purposes, precautions must be taken with regard to their inherent competitive nature.

Psychosocial development through Masters sport: What can be gained from youth sport models?

Although sport participation is encouraged throughout the lifespan, little research has been conducted on the role of sport in development later in life. This qualitative study explored adults' experiences of development within the context of Masters sport. We interviewed 14 adults (nine men and five women) aged 46-61 years involved in Masters sport. Data was interpreted drawing upon frameworks from youth sport (i.e., Personal Assets Framework for Sport; Côté, J., Bruner, M., Strachan, L., Erickson, K., & Fraser-Thomas, J. (2010). Athletes' development and coaching. In J. Lyle & C. Cushion (Eds.), Sport coaching: Professionalism and practice (pp. 63-83). Oxford, UK: Elsevier, Côté, J., Turnnidge, J., & Evans, M. B. (2014). The dynamic process of development through sport. Kinesiologia Slovenica, 20(3), 14-26, Côté, J., Turnnidge, J., & Vieerima, M. (2016). A personal assets approach to youth sport. In K. Green & A. Smith (Eds.), Routledge handbook of youth sport (pp. 243-255). New York, NY: Routledge; 4/5Cs of positive youth development; Lerner, R. M., Fisher, C. B., & Weinberg, R. A. (2000). Toward a science for and of the people: Promoting civil society through the application of developmental science. Child Development, 71(1), 11-20. doi:10.1111/1467-8624.00113; Vierimaa, M., Erickson, K., Côté, J., & Gilbert, W. (2012). Positive youth development: A measurement framework for sport. International Journal of Sports Science & Coaching, 7(3), 601-614. doi:10.1260/1747-9541.7.3.601), combined with past research on mid-life and older athletes. Six key themes emerged as contributing to adults' personal development through sport: competence and confidence, character, commitment, connection, cognition, and challenge. Masters sport contexts appeared to facilitate changes in assets (i.e., 6Cs) similar to those within youth sport, but assets often held different meanings within the context of later life. Applying frameworks from youth sport and developmental psychology to Masters sport contexts appears useful. The current findings support the modification of existing models and highlight their potential in identifying lifelong developmental outcomes of sport participation.

Relational developmental systems metatheory: a conceptual framework to understand and promote older adults' involvement in sport

Sport is viewed as a vehicle to develop or augment adaptive developmental processes, resources, and experiences across the lifespan. However, research has acknowledged that sport participation is associated with costs as well as benefits in older adulthood. To fully understand the influence of sport participation on psychosocial and developmental outcomes in older people, insight into the dynamic and complex relationship between the individual and his/her environment is needed. This review proposes Relational Developmental Systems (RDS) metatheory as a conceptual framework to understand the outcomes of sport participation later in life. Knowledge of the mechanisms, processes, and bi-directional exchanges related to individual and contextual relations emphasised in RDS frameworks may help researchers gain an understanding of the means by which sport participation shapes developmental outcomes evident within and among older athletes. Key assumptions of the metatheory are introduced and discussed in relation to the sport setting. Specific examples from the literature on older athletes are presented to illustrate the relationship between individual and contextual factors on developmental outcomes. Finally, considerations for future research on the topic are proposed using an RDS lens to move the field forward.

The Effect of Floorball Training on Health Status, Psychological Health and Social Capital in Older Men

This article presents the results of a multidisciplinary study which investigated the effects of a period with floorball training on health status, psychological health and social capital of older men. Thirty-nine untrained men aged 69.9 ± 0.6 (range: 65-76) were randomized into a group playing floorball (n = 22) or a group playing petanque (n = 17) one hour twice a week for 12 weeks. Both groups filled out the Health Survey Short Form (SF-12) and the Hospital Anxiety and Depression Scale (HADS) before and after the 12-week intervention. Linear regression analyses with bootstrapping showed that the men in the floorball group improved in the SF-12 composite score for mental health, as well as the HADS subscales anxiety and depression, compared to the men in the petanque group. In addition, 21 interviews were conducted with a sample of the men engaged in floorball. According to the statements in the interviews, the men in the floorball group experienced a high degree of solidarity and group cohesion which seemed to have increased their social capital during the intervention. In particular, the fun and joyful experiences of playing led to a high degree of social connectedness, which were mentioned by many of the men as the main reason for their participation throughout the 12-week period. The statistical results and the interview findings suggest that participation in a ball game such as floorball has several benefits regarding health status, psychological health and social capital and in addition that playing floorball is experienced as enjoyable amongst older men. Thus, it can be concluded that floorball is an activity that benefits older men and should be provided in relevant contexts, such as e.g. sport clubs or centres for seniors.

Older people's adherence to community-based group exercise programmes: a multiple-case study

BACKGROUND

Physical inactivity is a global phenomenon, with estimates of one in four adults not being active enough to achieve health benefits, thus heightening the risk of developing non-communicable diseases. In order to realise the health and wellbeing gains associated with physical activity the behaviour must be sustained. Community-based group exercise programmes (CBGEP) utilising social supports have been shown to be one means of not only increasing activity levels for older people, but sustaining physical activity. A gap in the literature was identified around older people's long-term adherence to real-life CBGEP within a UK context. This study therefore sought to address this gap by understanding older people's ongoing adherence to CBGEP with a view to gaining further insight about which factors contribute to enabling people to sustain their physical activity levels.

METHODS

A multiple case study research design was employed to understand older people's (≥60 years, n = 27) adherence (≥ 69%, for ≥ 1 year) to three current CBGEP in the South- West of England. Qualitative data (participant observation, focus groups, documents, and interviews) were collected and analysed using inductive thematic analysis followed by the analytic technique of explanation building. Quantitative data were analysed using descriptive statistics and used to set the context of the study.

RESULTS

The current study offers five unique insights into real-life programmes which have been successful in helping older people maintain adherence for a year or longer. These included: factors relating to the individual, the instructor (particularly their personality, professionalism and humanised approach), programme design (including location, affordability, the use of music, and adaptable exercise content), social features which supported a sense of belonging, and participant perceived benefits (physical and psycho-social). These all served to explain older people's adherence to CBGEP.

CONCLUSIONS

These factors related to participant adherence of CBGEP must be considered if we wish to support older people in sustaining a physically active lifestyle as they age. These findings are of interest to practitioners and policy makers in how CBGEP serve to aid older people in maintaining a physically active lifestyle with a view to preventing non-communicable diseases and in maintaining social connectivity.

Adherence to community based group exercise interventions for older people: A mixed-methods systematic review

OBJECTIVE

Lifelong physical activity provides some of the best prospects for ageing well. Nevertheless, people tend to become less physically active as they age. This systematic review assessed the views and adherence of participants attending community based exercise programmes of ≥6month's duration.

METHOD

Searches were carried out in eight online scientific databases (January 1995-May 2014) to identify relevant primary studies. Studies were assessed for quality and data extracted. Results were synthesised thematically and narratively. Qualitative findings were compared against quantitative studies.

RESULTS

A total of 2958 studies were identified and screened against the inclusion/exclusion criteria. Ten studies met the inclusion criteria (five quantitative, three qualitative and two mixed-methods study designs). None were excluded on the basis of quality. Six key themes were identified from the qualitative studies as important for adherence to group exercise programmes: social connectedness, participant perceived benefits, programme design, empowering/energising effects, instructor and individual behaviour. The mean adherence rate of studies with comparable measures was (69.1% SD 14.6). When the views of participants from the qualitative synthesis were juxtaposed against the quantitative studies, programme design was a common feature across all studies.

CONCLUSION

Evidence surrounding these programmes is limited both in terms of long-term adherence measures and the views of participants. However, based on limited findings there is some indication that community based group exercise programmes have long-term adherence rates of almost 70%. Incorporating the views of older people into programme designs may provide guidance for innovative interventions leading to sustained adherence.