ReviewMotivators and barriers for physical activity in the oldest old: A systematic review
Highlights
► Literature was systematically reviewed for factors influencing physical activity. ► 61 motivators and 59 barriers for physical activity in the elderly were identified. ► No studies were found exclusively describing people aged 80 years and over. ► We provide some attention points when promoting physical activity in the oldest old.
Introduction
Regular physical activity (PA) is one of the major elements in general health prevention. On average, 30 min of moderate PA on a daily basis is recommended in order to obtain significant health benefits (Pate et al., 1995). Especially in elderly persons regular PA is essential to prevent the development and exacerbation of hypokinetic conditions, such as type 2 diabetes mellitus, coronary heart disease, sarcopenia, osteoarthritis and osteoporosis (Vogel et al., 2009).
In general, far too few people engage in PA. In West European countries such as Belgium, only one in two citizens attains a minimum of 2.5 h of moderate PA per week (Bayingana et al., 2006), and this proportion decreases to one in five at the age of 75 years and over. The same trend can be observed in other European (Rütten and Abu-Omar, 2004) and non-European industrialized countries (Ewald et al., 2009). Especially from the age of 80 years and over, PA shows a sharp decrease. Moreover, at higher ages, significant age-related loss of functional capacities occur, for which muscle atrophy (Castillo et al., 2003), muscle weakness (Fiatarone et al., 1994) and loss of aerobic capacity (Tanaka and Seals, 2008), exacerbated by a sedentary lifestyle, are major contributing factors. Consequently, for elderly persons, regular PA is essential for maintaining physical independency. Also in the oldest old, regular physical exercise results in a number of advantages, including higher self esteem, increased quality of life and less physical constraints (Heath and Stuart, 2002).
The older population is growing both in industrialized and developing countries. In 2009 1.5% of the world population was aged 80 years or over. This proportion is expected to increase almost fourfold over the next 50 years, and reaching 4.3% in 2050 (United Nations Department of Economic and Social Affairs, 2009). Consequently, improving and maintaining sufficient levels of PA in subjects aged 80 years and over represents worldwide an increasing challenge for public health.
In order to conduct optimal preventive life-style campaigns, it is important to identify the motivators and barriers for elderly persons to engage in PA. Participation in PA is a dynamic and complex process, influenced by various factors. Several internal factors (such as lack of interest, fear of falling), but also social support (by peers or family) and environmental factors (such as weather and access to infrastructure) can influence the physical behavior of elderly persons and their willingness to exercise (Dishman et al., 1985).
Recently, studies identifying motivators and barriers for PA have been systematically reviewed for subjects of different ages. For younger people (aged 18–30 years) weight management, social interaction and enjoyment were the main reasons for participation in PA. For middle-aged adults (aged 30–60 years) a sense of achievement, skill development, health benefits, network support and enjoyment through PA appeared to be motivators, whereas negative experiences with PA at school, anxiety in unfamiliar surroundings, lack of social network, identity conflict and lack of role models were mentioned as barriers. For adults aged 60 years or older, mostly the same motivators (social support, health benefits and enjoyment) were found. The main barriers for PA in these subjects were insufficient guidance and lack of role models (Allender et al., 2006). In general, systematic reviews focusing on elderly persons aged 80 years and over are scarce. In fact, because of their specific needs, it is conceivable that motivators and barriers for PA would be different for the oldest old than for younger subjects. The aim of this study was to review systematically the literature focusing on the identification of motivators and barriers for PA in subjects aged 80 years and over.
In reviewing the motivators and barriers for PA for the oldest old, the Social–Ecological Model as described by Mc Leroy et al. (McLeroy et al., 1988) was used as a framework to synthesize the factors influencing PA (see Table 1). The Social–Ecological Model was chosen because in other models (such as Stages of Change Model or the Self-Efficacy Model) the environmental causes of behavior are less integrated.
Section snippets
Literature search
Pubmed (using MESH-terms), Web of Science and PsychInfo were screened (last search on December 31st 2010) using the following keywords: (elderly OR aged 80 and over) AND (physical activity OR exercise OR motor activity) AND (motivation OR barrier). This action resulted in 623 hits. For these articles, titles and abstracts were screened for relevance. Studies were included if they were written in English and if they reported motivators and/or barriers for PA in subjects aged >79 years. When only
Results
We found 4 categories of studies:
- (1)
Studies aiming primarily to identify motivators and/or barriers for PA (18 articles).
- (2)
Studies assessing the impact of specific elements of behavior on PA (10 articles).
- (3)
Studies exploring the relationship of motivators and barriers with PA-level (3 articles).
- (4)
Studies mentioning motivators and barriers for PA as additional or secondary outcomes (14 articles).
We found 15 and 29 publications with respectively a qualitative and a quantitative study design involving a
Discussion
This is one of the first systematic reviews investigating motivators and barriers for PA in the oldest old (subjects aged 80 years and older). There is a growing demand for data regarding the oldest old and since the year 2000, research targeting this specific age-group has increased significantly (Tomassini, 2006). In this study, 61 motivators and 59 barriers for PA in the elderly were identified, including those who are relevant for persons aged 80 years and over. However it is currently not
Conclusion
Although several studies involving elderly at very high age were identified, the results of this systematic review show that motivations and barriers related to PA are not extensively described for the oldest old. Further research focused on the oldest old is warranted in order to identify specific targets in the development of efficient strategies to increase PA in this specific population. Intrapersonal barriers and motivators are most frequently reported. There is less research available
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