Dr. Weeks is Associate Professor, Department of Family & Nutritional Sciences, and Dr. Campbell is Associate Professor, School of Nursing, University of Prince Edward Island, Charlotte-town, Prince Edward Island, Ms. Profit is Assistant Professor, Nursing Program, Cape Breton University, Sydney, Nova Scotia, Ms. Graham is Assistant Professor, School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, and Ms. Chircop and Ms. Sheppard-LeMoine are Assistant Professors, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
The authors appreciate their collaborations with Dr. Lisa Votta, Dr. Nancy Edwards, and Ms. Katherine Holdway at the Community Health Research Unit, University of Ottawa. They thank Stacy Lewis, Olive Bryanton, Carol Smillie, Chris Pauley, and Tasha Ellis for their assistance. They also thank the seniors who participated in this study. Funding was provided by the Canadian Nurses Foundation and the Community Health Research Unit at the University of Ottawa.
Address correspondence to Lori E. Weeks, PhD, Associate Professor, Department of Family & Nutritional Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada, C1A 4P3; e-mail: Lweeks@upei.ca.
Appropriate levels of physical activity for seniors can improve fitness and performance scores, improve mobility, and reduce risk for falls (Chin A Paw, van Poppel, Twisk, & van Mechelen, 2006; Dinan, Lenihan, Tenn, & Iliffe, 2006). In a longitudinal study, Paterson, Govindasamy, Vidmar, Cunningham, and Koval (2004) found that lower cardiorespiratory fitness was significantly associated with increased odds of becoming dependent, such as living in a long-term care facility or requiring home care services. Thus, identifying how to maintain appropriate levels of physical activity for seniors is advantageous.
Researchers have identified various determinants of participation in physical activity for seniors. Many of these are related to health and interpersonal characteristics. In some cases, seniors may increase levels of physical activity to manage symptoms following a chronic disease diagnosis or an exacerbation of symptoms such as pain (Holdway, 2001). In a large quantitative study, Jiménez-Beatty Navarro, Graupera Sanz, del Castillo, Izquierdo, and Rodríguez (2007) found that physical health factors, such as improvement in physical or motor competence, and social relationship factors, such as spending time with others, are important motives for older adults to engage in physical activity. Seniors who are unmarried or have a partner who is inactive are less likely to engage in regular physical activity (Pettee et al., 2006). In addition, depression has been linked with lower activity levels (Lindwall, Rennemark, Halling, Berglund, & Hassemén, 2006).
Historical and environmental factors also affect participation in physical activity. In young and middle-aged adults, past and recent history of engaging in regular physical activity is a predictor of future behavior (Strain, Grabusic, Searle, & Dunn, 2002; Thompson, Humbert, & Mirwald, 2003). A life course of sedentary activity is likely to continue in the senior years (Kluge, 2002). The effect of environmental factors on levels of physical activity has also been recognized (Frank & Engelke, 2000; Lockett, Willis, & Edwards, 2005). For example, in a qualitative study, Strath, Isaacs, and Greenwald (2007) found that for older adults, physical features in their community, such as the condition of sidewalks, can either support or act as a barrier to physical activity.
Although more research on older adults’ physical activity has focused on community-dwelling seniors, evidence from research with seniors in nursing homes shows that participation in exercise can be advantageous. For example, Rolland et al. (2007) found that an exercise program consisting of walking, strength, balance, and flexibility training led to a significantly slower decline in activities of daily living. In addition, Chen, Hsu, Chen, and Tseng (2007) found that nursing home residents’ physical and social functioning significantly improved after participating in a tai chi exercise program. Although most research on physical activity with nursing home residents is quantitative, Stathi and Simey’s (2007) qualitative study revealed that nursing home residents can have very positive experiences through exercise participation, including better function and mobility, greater independence, and more social interaction and fun.
© 2008/frank Rosenstein/photodisk/getty Images
Whereas there is little research emphasis on comparing physical activity among older adults residing in long-term care facilities with that of seniors living in the community, existing evidence shows that nursing home residents exhibit lower levels of physical activity than do seniors living in the community (Morris et al., 1999). In particular, Cyarto, Myers, and Tudor-Locke (2004) found that ambulatory seniors in nursing homes walked significantly slower and had significantly more gait disorders than did community-dwelling seniors. These differences in activity levels may be due to variations in the number and kinds of activities available to seniors living in the community and in long-term care facilities.
Resnick and Galik (2007) developed a comprehensive survey to measure physical activity of long-term care facility residents that included routine physical activity, such as walking; personal care activities; structured exercise classes; recreational activities, such as arts and crafts; providing care to others; and repetitive activities exhibited by people with dementia. This instrument can be useful in identifying and measuring the various kinds of physical activity offered in long-term care.
Thus, most research on physical activity and aging focuses on either community-dwelling or institutionalized seniors and is primarily quantitative (Grant & Cousins, 2001). Although knowledge on what variables are associated with exercise participation in later life is increasing, expanding nurses’ understanding of how to increase physical activity among seniors is advantageous, whether they are working with seniors in long-term care settings or those living in the community. The purpose of this qualitative study was to identify overarching factors that influence participation in physical activity among seniors in the community and in long-term care facilities.
To be eligible for participation in the study, seniors had to be at least age 64 and were required to have the manual dexterity necessary to handle a camera, the ability to ambulate independently with or without the use of an assistive device, and to be able to communicate orally in English or French. Seniors were excluded from participation if they were not able to ambulate outside of the home or were unable to provide informed consent. Literacy was not an exclusion criterion.
We recruited participants from three sites, including residents of a privately operated, 112-bed skilled nursing home and clients of two community-based organizations. These sites were identified by the authors because of their potential to recruit eligible study participants. At each site, personnel were introduced to and informed of the study procedures by a research assistant. In the nursing home, an administrator identified eligible residents and invited them to participate in the study. At one community site, staff of a nonprofit health care agency identified and contacted eligible clients. At the second community site, the board of a seniors center identified and contacted eligible individuals. Nursing home residents and community-dwelling seniors from the two sites who indicated they may be interested in the study were then approached by a research assistant who determined their eligibility, invited their participation, and obtained their consent. A total of 30 participants were recruited from two Canadian provinces. Of the 24 participants who completed the study, 17 were community dwelling and 7 lived in the nursing home.
After consenting to participate in the study, the seniors participated in a face-to-face interview with a research assistant. The research assistant recorded the participants’ oral responses to a sociodemographic and physical activity profile on a form. The sociodemographic profile included questions on age, gender, marital status, living arrangement, education, and financial status. Physical activity profile questions included the number of days per week the seniors participated in various kinds of exercise for a minimum of 20 minutes per day. The kinds of exercise included vigorous activity (e.g., exercise program, brisk walking), moderate activity (e.g., gardening, walking), and light activity (e.g., strolling). In addition, the seniors indicated how many days per week they participated in sedentary activities (e.g., reading, watching television). Then, the research assistant audiotape recorded the seniors’ responses to a series of open-ended questions about perceptions, barriers, and facilitators to physical activity for older adults. The face-to-face interviews lasted approximately 45 minutes each.
Data from the sociodemographic and physical activity profiles were entered into SPSS version 11 for Windows for statistical analysis. After completing verbatim transcriptions, another research assistant entered the qualitative data from the semi-structured interviews into QSR International’s N6 software package. This computer software facilitates non-numerical data management for the interpretation and coding of data.
The authors conducted a thematic analysis of the qualitative data to identify influences on the study sample’s participation in physical activity. Thematic analysis is a kind of pattern recognition within the data, allowing for themes to emerge directly from the data using inductive coding (Fereday & Muir-Cochrane, 2006). Thematic analysis is particularly useful in understanding influences and motivations that affect how people respond to events (Luborsky, 1994). Thus, thematic analysis lends itself well to understanding meaning in relation to the physical activity behaviors of the study participants. We developed an organizing structure across the narratives through the identification of an overarching theme and five subthemes.
Sociodemographic and Physical Activity Profile
The sample included a large proportion of women (79.2%) and adults ages 64 to 84 (70.8%) (Table). Most participants were either widowed (54.2%) or married (33.3%), and many lived alone (58.3%). Participants had completed high levels of education for this age group, with 54.2% having a college diploma or beyond. Many respondents (45.8%) reported that their income only met their needs either somewhat or moderately.
Table 1: Sociodemographic Profile of Study Participants
Self-reported physical activity levels varied between the community-dwelling seniors and those living in a nursing home. The community-dwelling seniors participated in vigorous exercise a mean of almost 4 days per week, whereas no nursing home residents participated in vigorous activity. In addition, more nursing home residents participated in sedentary activities (5.3 days per week) than did community-dwelling seniors (3.5 days per week).
Influences on Physical Activity Participation
We identified the following overarching theme that helps structure our key findings: “To understand the factors that influence seniors’ participation in physical activity, it is necessary to take into account past experiences, life transitions, and future concerns.” This overarching theme helps explain the complexity of the issue of physical activity participation in later life. The five subthemes identified that supported the overarching theme are presented below.
Intergenerational Influences. The context in which the seniors grew up emerged as an important factor in understanding lifelong physical activity participation. The seniors appeared to be influenced long term, either in a positive or negative way. This appeared to be related to their parents’ attitude toward physical activity and participation in physical activity. In some instances, the seniors told of memories as children when their parents participated in physical activity. One woman explained how her mother influenced her own attitudes toward physical activity:
I think probably in the past it was my mom, who was quite physical. She did her own housework; she always washed, picked berries; they picked apples. She was always into physical activity. Making her own jam. I think she was probably the one who influenced me most.
However, for other respondents, their parents influenced them in a negative way. One senior said:
Well, I think it is an age thing. When I was young, no one talked much about physical education or physical activity. My mother, if you said to my mother, I am going to join [an exercise program, she would say], “Are you out of your mind?”
It became apparent that a parent’s participation in physical activity into older age influenced the respondents’ participation. They saw their parents participating in physical activity not only as young or middle-aged adults, but well into later life. Respondents’ stated:
- Well, she [the respondent’s mother] is in the pool every day, walks the track over there behind the fire hall. She will go over there. It is a quarter mile…. She skated three times a week until she broke the hip the last time. She was 91 then.
- My father too was very physical. He was a hard worker, did his own work, and they were working way up in their 90s. They just kept going.
When most of the respondents spoke of their parents’ participation in physical activity as younger adults or in later life, they spoke with a great deal of admiration. This inter-generational role modeling appeared to have an impact on many seniors in this study.
Establishment of Early Physical Activity Patterns. Many respondents participated in physical activity throughout their lives, continuing the activity patterns established many decades earlier. Some described participating in activities such as dancing, skiing, and swimming all their lives, and in some cases, they were still able to continue these patterns of activity. One senior said:
One thing I have always loved, and I am still doing a fair amount of it when I can, is traveling…. And I mean if you are on a tour, you are moving, and there’s a lot of activity in that.
Other respondents described lifelong patterns of certain kinds of physical activity that they had never enjoyed or participated in, for a variety of reasons. Some had a negative experience in the past that had a lifelong influence. One respondent said, “I was never sports minded. I don’t like being rough and tumble in sports. I am too afraid of getting hurt.”
Although some respondents began a new kind of physical activity in later life, such as walking, that had not been an earlier pattern, it appeared that a great deal of current physical activity participation was linked to earlier physical activity participation.
Family Transitions Over the Life Course. For many respondents, especially the women in this study, strong links emerged between participation in physical activity and family transitions over the life course. In particular, the two primary areas included providing care to children and providing care to spouses and parents. Many of the seniors had large families and very busy lives that often included paid work. Thus, they had little time for any kind of physical activity when they were younger, and this appeared especially true for many women in this study. For some women, this seemed to have a negative effect on their later physical activity in that some were welcoming a time when they could rest. Respondents stated:
- Well, I had nine children (laughs)…. I didn’t have time to think about physical activity. I had a job. I had two jobs most times and a family. Now I have more time not to do anything, and that is dangerous…. Now that I have time to sit, I don’t have to do anything all day if I don’t want to.
- I used to ride a bicycle, way, way back, but I don’t do that anymore…. No, when you are busy raising children, working. Now I have the time, [but] I am too lazy.
- I figured all my life I got up at six o’clock in the morning to get a husband to work, to get children to school, and myself to work. I don’t really need to get up.
The demands of providing care to spouses and parents appeared to be quite detrimental to some respondents, and this experience affected their physical activity. Some women recognized caregiving involved physical activity but that it also kept them from doing the kinds of physical activity that may have been more beneficial to them. Two seniors said:
- Well, he [spouse] was sick for 9 months, and then the year after was just, I don’t even remember it, I was so tired and run down and everything. It kind of put me out of the loop. I don’t do anything that I used to.
- When Mom was sick, I had a hard time doing anything physical outside. Because I could not leave; she did not want me to leave her. I could not get anyone in either because she did not want anyone in. So I was sort of trapped, and I blame my osteoporosis on that 3-year span because I wasn’t exercising.
One woman providing simultaneous care for her husband and mother experienced a great deal of difficulty finding time to participate in physical activity:
My mother is 95, and she has a lot of physical problems, and we went [to an exercise program], three of us, for about 3 years…but then Mom has other health problems, and we had to stop…and because I was always looking out for them. But I am just watching my chance, and as soon as I get the opportunity, I will be back. Because I enjoy that, a little bit with weights.
Changing Health Status Over the Life Course. In addition to changing family responsibilities over the life course, changing health status over the life course appeared to have a significant effect on the physical activity participation of the seniors in this study. For some participants, changes in health status eliminated certain kinds of physical activity:
- I am not able to lift heavy things anymore…because of the osteoporosis in my back, but I manage myself quite well. I know what I am allowed to lift and not. When I have to lift something heavy, I get help. So I really restrain myself from heavy lifting.
- I went to yoga one time, and I was just lying back. I was just trying to raise my head. I can’t do that. I get sick and dizzy; I really do. I can’t bend a lot. I have problems with my esophagus. I also have arthritis in my lower part of my back.
For others, changing health status caused the participants to modify the kinds of physical activities in which they could engage, or they may have participated in the same kind of physical activity but at a different level they could manage with their current abilities. Respondents said:
- Sore knees. I noted that in my knees, there [are] a lot of things that I can’t do. But then I bought stools…. I think of going down on my knees and having that stool in front of me to press down to get back up.
- I found out even last year, even perhaps 2 years ago, I found if I gardened an hour, you know, on your hands and knees and up and down, it was about my limit.
- I’m hoping to get into an exercise program. I can get back to a little bit of it because I think that is one of the healthiest kinds of exercise. I won’t do it without advice because my heart has substantially changed recently.
For the seniors living in a nursing home, health changes were an important reason they had limited their participation in physical activity. In many instances, their health declined to the point where they needed the assistance of a staff person to participate in physical activity. Some nursing home residents indicated that they would participate in more physical activity if more personal assistance or encouragement to do so were provided. One respondent said, “The girl was going to take me out yesterday, but I forgot what was going on. See, they, they only can spend so much time with you.”
Future Health Concerns. A key motivator for participating in physical activity for these seniors involved preventing further or anticipated future health decline. Some participants knew of others whom they believed experienced negative health outcomes because they did not participate in physical activity. This served as a powerful motivator for them to participate in physical activity. These seniors stated:
- I have all kinds of friends that have had hips done and knees done, and I am not about to have anything done. I am going to keep active, and I am going to make sure that is not going to happen.
- They [friends] never do anything, and I see how it is slowing them down and gaining weight. So that kind of encourages me.
- When you see someone who is your age and you went to school with, and you see them walking down the aisle in church holding onto every pew, and then it makes you realize that I have to keep doing this [physical activity].
- I don’t want to get osteoarthritis. My mother had it, and all she had to do was bang her hand up against a wall, and she would break a finger or something.
Many participants explained that they continued to participate in physical activity to stay mobile and to prevent injuries, such as falls:
- I don’t want to fall and break my leg or…fall and break anything. So I think strengthen, use some weights, and things like that to keep your bones strong.
- Because if I don’t, I won’t be able to move. I have arthritis. When I get up in the morning, everything aches. So I move around. My legs in particular. If I didn’t walk, my legs would bother me a lot.
Some seniors in a nursing home were motivated to keep as active as possible to prevent future decline.
- I just think the body was made to use it or lose it.
- I think it is important to not let yourself get into a state where you just sit and look out the window. I go to the activity room and look around…. I don’t like to just sit.
Several participants referenced how physical activity can help keep a person young and feel better:
- Because when I walk my 6 miles in the morning, I feel like someone gave me a shot of morphine…. I find it good for everything—your breathing and your mental state.
- Because it makes me feel good. I don’t want to be sitting around and fall into this not doing anything. I want to keep myself in shape and try to keep myself healthy as long as I can.
It was evident that these study participants believed physical activity was a key element in maintaining their health and/or preventing future decline.
Our overarching theme takes into account the influence of past experiences, life transitions, and future concerns on seniors’ participation in physical activity. Thus, it is advantageous for nurses to acquire in-depth knowledge about individual seniors to gain insight into their past and present participation in physical activity and their concerns for the future. This may lead to increased awareness of current facilitators and barriers to participation in physical activity and provide strategies for engaging in appropriate long-term physical activity.
Our overarching theme can be examined from a life course perspective. This perspective allows for how the historical context and personal situation shapes past, current, and future experiences (Elder, 1985). In a qualitative study of older adults’ beliefs about physical activity, Scanlon-Mogel and Roberto (2004) noted how physical activity participation varied over the life course, depending on historical, societal, and environmental changes. A life course perspective allows us to broaden our view of what influences physical activity among seniors and thus has a greater impact on the health of seniors.
Although we used thematic analysis to identify our overarching theme and subthemes, on the basis of the data gathered from seniors both in the community and in a nursing home, specific differences did emerge between the two groups. Our results contribute to the scant knowledge on differences in activity levels between seniors in nursing homes and those living in the community (Cyarto et al., 2004; Morris et al., 1999). In particular, we found that the nursing home residents in our study did not participate in vigorous exercise at all, and they more often participated in sedentary activities than did seniors living in the community. More research with larger samples is needed to generalize findings on differences in activity levels between seniors in nursing homes and in the community.
Our results indicate that the low level of physical activity exhibited by seniors in a nursing home is of concern. Chin A Paw et al. (2006) found that seniors are most likely to participate in exercise programs that are offered by trained staff twice per week. Results from our study point to the necessity of having nursing home staff available and trained to work with seniors to help them participate in physical activity because these seniors may have reduced health abilities or motivational levels for physical activity participation. Hui and Rubenstein (2006) suggested that staff should be involved in educating seniors, dispelling myths, and implementing creative solutions to perceived barriers of exercise participation. The fact that physical activity is necessary for seniors needs to be reinforced so nursing home resources are dedicated to various kinds of physical activity.
Fewer men than women participated in this study, and some key results may be more salient for women. For example, the women in this study provided many examples of how various family caregiving responsibilities over the life course had influenced their participation in physical activity. In their qualitative study of older men and women, Scanlon-Mogel and Roberto (2004) found that family responsibilities influenced participation in physical activity. Examining a larger group of older men may result in additional findings that can provide a better understanding of what influences physical activity participation and whether there are distinct gender differences.
Our findings contribute to the existing knowledge about factors that influence seniors’ participation in physical activity. The results emphasize how factors in early life, life transitions, and future concerns affect physical activity participation for seniors. Our analysis, resulting in an overarching theme and five sub-themes, provides a framework from which to examine these factors. The results also suggest the advantages of nurses’ gaining an in-depth understanding of seniors’ life history to increase their participation in physical activity.
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Sociodemographic Profile of Study Participants
|Community Dwelling (n = 17)||Nursing Home (n = 7)||Total (N = 24)|
|Variable||n (%)||n (%)||n (%)|
| Men||3 (17.6)||2 (28.6)||5 (20.8)|
| Women||14 (82.4)||5 (71.4)||19 (79.2)|
| 64 to 74||9 (52.9)||1 (14.3)||10 (41.7)|
| 75 to 84||3 (17.6)||4 (57.1)||7 (29.2)|
| ≥85||1 (5.9)||2 (28.6)||3 (12.5)|
| No response||4 (23.5)||0 (0)||4 (16.7)|
| Single||2 (11.8)||1 (14.3)||3 (12.5)|
| Married/common law||8 (47.1)||0 (0)||8 (33.3)|
| Widowed||7 (41.2)||6 (85.7)||13 (54.2)|
| Alone||7 (41.2)||7 (100)||14 (58.3)|
|With someone else||9 (52.9)||0 (0)||9 (37.5)|
| No response||1 (5.9)||0 (0)||1 (4.2)|
|Highest educational level|
| Less than high school||2 (11.8)||3 (42.9)||5 (20.8)|
| High school diploma||5 (29.4)||0 (0)||5 (20.8)|
|College diploma or beyond||9 (52.9)||4 (57.1)||13 (54.2)|
| No response||1 (5.9)||0 (0)||1 (4.2)|
| Somewhat||1 (5.9)||2 (28.6)||3 (12.5)|
| Moderately||5 (29.4)||3 (42.9)||8 (33.3)|
| To an extent||6 (35.3)||1 (14.3)||7 (29.2)|
| To a large extent||5 (29.4)||1 (14.3)||6 (25)|