Research in Gerontological Nursing

Empirical Research 

Reminiscence About Physical Activity: A Pilot Study to Reduce Pain in Older Adults

Juliette Shellman, PhD, APHN-BC; Deborah Dillon McDonald, PhD, RN; Joseph Ferraro, BS, RN; Erin Milner, BS, RN

Abstract

The aim of the current randomized attention control pilot study was to conduct a preliminary test of a facilitated reminiscence intervention about past physical activity for the effect on increased physical activity and reduced pain in older adults with osteoarthritis. Thirteen older adults were randomized to the facilitated reminiscence or health education group and participated in six individual sessions over 6 weeks. Reminiscence functions, self-reported physical activity, pain intensity, and pain interference with function were measured at baseline and 1 and 3 months postintervention. Facilitated reminiscence did not result in increased physical activity, but instead resulted in increased pain intensity. Content analysis of reminiscence session transcripts indicated most reminiscence was conversational. Benefits from reminiscence included reconnecting with estranged family and distraction from pain. Past physical activities might be helpful to include as part of a program of facilitated integrated reminiscence for individuals with sufficient history of past physical activity.

[Res Gerontol Nurs. 2019; 12(4):193–202.]

Abstract

The aim of the current randomized attention control pilot study was to conduct a preliminary test of a facilitated reminiscence intervention about past physical activity for the effect on increased physical activity and reduced pain in older adults with osteoarthritis. Thirteen older adults were randomized to the facilitated reminiscence or health education group and participated in six individual sessions over 6 weeks. Reminiscence functions, self-reported physical activity, pain intensity, and pain interference with function were measured at baseline and 1 and 3 months postintervention. Facilitated reminiscence did not result in increased physical activity, but instead resulted in increased pain intensity. Content analysis of reminiscence session transcripts indicated most reminiscence was conversational. Benefits from reminiscence included reconnecting with estranged family and distraction from pain. Past physical activities might be helpful to include as part of a program of facilitated integrated reminiscence for individuals with sufficient history of past physical activity.

[Res Gerontol Nurs. 2019; 12(4):193–202.]

Older adults with osteoarthritis pain often do not participate in exercise because they believe that physical activity will increase their pain and worsen their condition (Kanavaki et al., 2017). However, it has been shown that aerobic, resistance, and physical exercise generally reduces osteoarthritis pain (Juhl, Christensen, Roos, Zhang, & Lund, 2014). Physical activity programs designed specifically for older adults with osteoarthritis such as Joint Academy®, a web-based treatment program for older adults with knee or hip osteoarthritis, reduce pain and increase physical activity (Nero, Dahlberg, & Dahlberg, 2017). Despite these findings, only 12.7% of adults age 65 and older meet the federal 2008 recommended physical activity guidelines for Americans (Centers for Disease Control and Prevention, 2017). The challenge remains to identify factors that support older adults to engage in safe, sustained physical activity so that they can achieve significant pain reduction. Reminiscence of past enjoyable physical activities might motivate older adults to re-engage in safe physical activities. The aim of the current research was to pilot test a reminiscence intervention, reminiscence of past physical activity, for increased physical activity and reduced pain in older adults with osteoarthritis.

Reminiscence can be defined as the recollection of past experiences. This naturally occurring process may take place individually, occur silently, or be conducted as part of a group process, and is enhanced in the presence of a supportive listener (Butler, 1963; Westerhof, Bohlmeijer, van Beljouw, & Pot, 2010). There are several types of reminiscence. Watt and Wong (1991) developed an empirically based taxonomy that includes: (a) simple or narrative reminiscence in which an individual recalls past events without analysis; (b) transmissive reminiscence involving transferring wisdom from one generation to another; (c) integrative reminiscence, which is more evaluative in nature where through this process there is acceptance of self and integration of the past and present; (d) escapist reminiscence or defensive reminiscence, which occurs when an individual seeks comfort from events or people; (e) instrumental reminiscence, a problem-solving type of reminiscence that draws on experiences to solve present day problems; and (f) obsessive reminiscence in which an individual ruminates about unpleasant experiences creating feelings of resentment, guilt, and shame. Watt and Wong's (1991) taxonomy led to research on reminiscence functions to better understand the different uses of reminiscence and its associations with mental health and well-being in older adults.

Webster (1993, 1997) developed an empirically based taxonomy of eight reminiscence functions including: (a) conversation, defined as a social type of reminiscence serving a more social function where memories are shared without evaluation; (b) death preparation, where one reviews experiences to come to terms with one's own mortality; (c) self-identity is the process of reviewing memories to make meaning of one's life and to gain a sense of self; (d) bitterness revival is having the tendency to review painful memories; (e) intimacy maintenance involves reminiscing to keep the memories of a lost loved one alive; (f) boredom reduction refers to thinking about the past to fill a void; (g) teach and inform is used to pass on knowledge to younger generations; and (h) problem solving, which is defined as reminiscing about past experiences to solve current problems. The eight functions have been found to cluster into three factors: (a) self-negative functions (bitterness revival, intimacy maintenance, boredom reduction); (b) self-positive functions (self-identity, death preparation, problem solving), and (c) prosocial function (conversation and teach and inform) to form a tripartite model of reminiscence functions (Cappeliez & O'Rourke, 2006). Cross-sectional survey research has shown a direct and negative relationship between self-negative functions and a direct and positive relationship between self-positive functions and perceived health (Cappeliez & O'Rourke, 2006; O'Rourke, Cappeliez, & Claxton, 2011). The pro-social reminiscence function has been indirectly associated with psychological and physical health through the self-positive and self-negative functions (Cappeliez & O'Rourke, 2006; O'Rourke, Bachner, Cappeliez, Chadbury, & Carmel, 2015).

Research has shown the positive impact of reminiscence interventions on psychosocial outcomes (Apostolo, Queiros, Rodrigues, Castro, & Cardosa, 2015; Pinquart & Forstmeier, 2011). However, no known research exists that examines the impact of reminiscence on increasing physical activity and decreasing pain.

Theoretical Underpinnings

The Theory of Cognitive Adaptation (O'Rourke, 2002) provides the framework for the integrative reminiscence process. According to this theory, the way people interpret their interpersonal relations and life histories is significantly associated with wellness in later life. The key construct of the theory is “cognitive reconstruction.” Individuals are helped to think differently about a phenomenon. Through integrative reminiscence there is reconstruction of negative thoughts, attitudes, and beliefs. The strategies that promote integrative reminiscence as an intervention to promote positive thinking are: (a) identifying and shifting negative thoughts, (b) generating alternative thinking about the past (reframing thinking), (c) identifying coping and problem-solving skills, and (d) emphasizing competence (Cappeliez, 2007). These strategies result in cognitive reconstruction of older adults and allow for new ways of thinking about their lives. For the purposes of the current study, participants were encouraged to reflect on their exercise experiences throughout their lives. Positive experiences were encouraged and validated. Negative thoughts about exercise were reflected on and examined during the sessions. Reminiscence facilitators were trained to reframe negative thoughts by emphasizing strengths and coping strategies, so that participants might view exercise in a more positive way.

The Theory of Trialing to Pain Control describes the process used to gain control over pain as patients work closely with their practitioners to trial pain treatments (McDonald, 2014). A critical component of the trialing process involves initiating treatment trialing (e.g., physical activity). Being optimistic, committing to try, and being open to revising treatments are crucial factors for initiating trialing (McDonald, 2014). Trialing treatments, such as physical activity, involves using the treatment over sufficient time to allow treatment effects to emerge. Evaluation of the risk/benefit of the treatment guides continuation, modification, or discontinuation of the treatment. Reminiscence might contribute to positive coping and problem solving as physical activity is trialed to reduce osteoarthritis pain.

Physical inactivity and pain are two major public health threats. An estimated 29.1% of adults in the United States are physically inactive (Wall et al., 2018), and approximately 50 million experience chronic pain, which costs an estimated $560 billion per year (Dahlhamer et al., 2018). Reminiscence is a highly innovative approach to improving public health by increasing physical activity and decreasing osteoarthritis-associated pain. The following hypothesis was pilot tested: Reminiscence participants will report more physical activity and less pain interference with function at 1 and 3 months postintervention compared to attention control participants.

Method

Design

A randomized attention control pilot was used to conduct a preliminary test of reminiscence of past physical activity between the treatment group receiving reminiscence and the attention control group receiving health education. Outcomes were increased physical activity and decreased pain interference with activity at 1 and 3 months.

Sample

Because the current study was a planned pilot study, the original goal for sample size was 20. However, recruitment was challenging. The majority of potential participants cited length of time of the study as the reason for not participating. To complete the study within an appropriate time frame, recruitment ended after 10 months. Fourteen English-speaking adults age 65 and older who reported pain intensity from their lower extremity osteoarthritis of at least 4 on a 0- to 10-point numeric rating scale the majority of days in the past 1 month comprised the initial sample. Pain intensity of 4 indicates moderate pain, and therefore, a greater need to reduce the pain. Participants were recruited from congregate senior housing sites in the northeastern United States. The research took place from January through October 2016. One participant withdrew from the study after consent but prior to data collection or sessions due to lack of personal time. The final sample comprised 13 older adults, with eight randomized to the reminiscence group and five to the attention control health education group. All 13 participants completed the entire 6 weeks of reminiscence/health education sessions.

Reminiscence Intervention

The reminiscence intervention, based on the Theory of Cognitive Adaptation (O'Rourke, 2002), comprised six weekly, 60-minute integrative reminiscence sessions privately conducted by a trained reminiscence facilitator nursing student. Two facilitators were trained by a reminiscence expert to conduct integrative reminiscence using active listening skills, encouraging reflection, and validating life experiences. To maintain continuity, the same facilitator completed all reminiscence sessions with the same participant. Participants were asked to share past physical activity experiences that included play, organized sports, health, and work from childhood through the present. Each session generally covered two topics. The reminiscence topics/questions are listed in Table 1. Intervention fidelity was monitored by one of the principal investigators who reviewed portions of the audiorecorded sessions, with feedback to facilitators as needed.

Reminiscence Session Topics/Questions

Table 1:

Reminiscence Session Topics/Questions

Attention Control Condition

The attention control condition comprised health education sessions for 6 weeks, 60 minutes once per week privately conducted by a trained nursing student. The six topics, with one discussed per session, included general tips for medication management, general nutrition tips, vision health, stroke prevention and recognition, healthy sleep habits, and information about nutritional supplements. Exercise, reminiscence, and pain management treatment were not included in any of the discussions.

Instruments

Brief Pain Inventory Short Form (BPI-SF). The BPI-SF was used to measure pain interference with function. The BPI-SF was developed to examine the prevalence and severity of pain in the general population (Daut, Cleeland, & Flanery, 1983). The BPI-SF comprises 15 questions that measure pain location, intensity, pain treatment, and the effect of pain on mood and everyday activities. Zalon (1999) compared the BPI-SF with the Short Form McGill Pain Questionnaire (SF-MPQ) with a group of surgical patients. The correlation between the BPI-SF and SF-MPQ for pain over the previous 24 hours was 0.61 (p < 0.001), supporting concurrent validity. Internal consistency for the overall BPI-SF has been reported as α = 0.87 (McDonald, Shea, Rose, & Fedo, 2009). The BPI-SF was more sensitive to a clinical intervention for musculoskeletal pain than the SF-36 or the PROMIS Pain Interference measures (Kean et al., 2016). The mean pain intensity score and mean pain interference with function score were computed and used in the current research.

Physical Activity Scale for the Elderly (PASE). The PASE was used to measure physical activity in older adults within the past 1 week. The 10-item instrument measures sedentary activity, walking, light recreational activity, moderate recreational activity, strenuous activity, and muscle strengthening activity. General time estimates for each item include 0 = never, 1 = seldom (1 to 2 days), 2 = sometimes (3 to 4 days), and 3 = often (5 to 7 days). Hours per day engaged in the activity are also documented as 1 = <1 hour, 2 = ≥1 hour but <2 hours, 3 = 2 to 4 hours, and 4 = >4 hours. Household and work-related physical activity are also measured. Test–retest reliability over a 3-to 7-week period was r = 0.75, with reliability higher for mail respondents than telephone respondents (r = 0.84 and r = 0.68, respectively) (Washburn, Smith, Jette, & Janney, 1993). The PASE correlated well with the 6-Minute Walk Test (r = 0.68) (Harada, Chiu, King, & Stewart, 2001). PASE scores were significantly higher for older adults participating in community center activities than older adults living in retirement homes (Harada et al., 2001). The PASE was also sensitive to seasonal variations, which impact outside physical activity (Washburn et al., 1993). The PASE was scored according to the administration and scoring instruction manual (New England Research Institutes, 1991). The physical activity norms for gender and age groups (i.e., 65 to 69, 70 to 75, 76 to 100) were used to determine physical activity at or above the norm versus below the norm for each participant to provide a more clinically significant outcome measure.

Modified Reminiscence Functions Scale (MRFS). The MRFS was used to measure the functions used by older adults when they reminisce. The MRFS (Washington, 2009) is a 29-item, seven-factor Likert-type scale designed to measure what function reminiscence serves for the individual. The scale is a modified version of Webster's (1993, 1997) Reminiscence Functions Scale. The seven factors include self-regard, death preparation, bitterness revival, intimacy maintenance, teach/inform, boredom reduction, and conversation. Respondents are asked, “When I reminisce it is to....” Item examples include teach younger people about cultural values, prepare for death, or recall my past to help me know who I am now. Respondents are asked to rank each item on a 5-point scale as to how often they reminisce with the stated purpose in mind, where 1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = very often. The higher the score, the more frequent the individual reminisces for the stated purpose. The MRFS has been shown to be a reliable and valid scale for use with diverse older adult populations. Internal consistency of the sub-scales ranges from 0.73 to 0.91 (Shellman & Zhang, 2014; Washington, 2009).

Descriptive Measure

The descriptive portion comprised self-report regarding age; gender; race; ethnicity; highest level of education completed; marital status; years of osteoarthritis pain; comorbidities; weight; height; exercise and/or sports participated in during the lifetime; if their neighborhood is conducive/non-conducive to safe walking; use of assistive devices; and current medications, vitamins, herbals, or supplements.

End of Therapeutic Reminiscence Treatment Interview

The following open-ended statement was asked of each reminiscence participant at the conclusion of the sixth session, with neutral questions to clarify or expand on areas (e.g., “Tell me more about that”):

Feedback about your experience during the reminiscence sessions and as a result of the sessions is important to help us improve the reminiscence sessions. Please share all of your thoughts, feelings, and ideas about your reminiscence sessions until you have no more to say.

Procedure

The university Institutional Review Board approved the research. Following consent, participants were randomized via a web-based random number generator to the reminiscence group or attention control health education group. Older adults were scheduled to complete baseline measures (i.e., descriptive, BPI, PASE, MRFS) at a time convenient to them. The first of six individual sessions began immediately after baseline data collection. Sessions (reminiscence or attention control health education) were conducted once per week for 6 weeks. All reminiscence sessions were audiorecorded and transcribed for content analysis. Older adults were contacted via telephone 1 and 3 months after the final session for repeated BPI, PASE, and MRFS measurement. Upon completion of the 3-month measures, older adults in the therapeutic reminiscence group were interviewed for their feedback on the reminiscence sessions. Interviewers manually documented responses. Older adults were paid after the baseline measures and again after completion of the 3-month measures a total of $60. Older adults were thanked for their participation and informed that their contribution was completed.

Analyses

Descriptive statistics, including frequencies, means, and standard deviations, were computed to describe the sample. Cross tabulation analysis with chi-square statistic and t tests was conducted to compare the reminiscence and health education groups on baseline measures.

Physical activity scores were dichotomized to at the norm versus below the norm for gender and age. The norms were as follows: women age 65 to 69, score = 112.7; women age 70 to 75, score = 89.1; women age 76 to 100, score = 62.3; and men age 76 to 100, score = 101.8.

The two pain measures were computed for change from baseline to Month 3. Pain interference with function change was computed by subtracting pain interference with function at baseline from pain interference with function at Month 3. Pain intensity change was computed by subtracting pain intensity at baseline from pain intensity at Month 3.

Content analysis based on Krippendorff's (2013) methods was conducted with responses to the open-ended question for feedback about the reminiscence sessions. Two trained raters independently coded responses for positive and negative comments. For example, comments about viewing life in a more positive way were coded as positive comments, whereas comments about reminiscence bringing up negative memories were coded as negative comments. Coding was compared and discussed to reach consensus.

Content analysis was also conducted for type of physical activity (e.g., recreation, health, work) and reminiscence function used (e.g., conversation, teach and inform, boredom reduction, intimacy maintenance, bitterness revival, self-regard, death preparation) when describing physical activity on the 48 transcribed reminiscence sessions. The criteria for reminiscence function coding were based on previous work conducted by Shellman (2016). For example, the reminiscence function of conversation was defined as reminiscence that serves a social function in which memories are shared without evaluation. Physical activity codes were defined for recreation, work, and health. For example, recreation was defined as physical activity for play or social interaction. Two trained independent raters coded the transcripts and compared coding. Disagreements were resolved through discussion. Results were summarized with frequencies.

Participant 1 (reminiscence group) had surgery after completing the reminiscence sessions but prior to the 1- and 3-month measures. The three analyses testing differences between the reminiscence and health education group for physical activity, pain interference with function, and pain intensity were conducted without Participant 1 to avoid the confound of surgery improving physical activity and reducing pain.

Results

A total of 13 older adults participated, with eight randomized to the physical activity reminiscence group and five randomized to the health education attention control group. The majority in both groups were White non-Hispanic widowed females with a high school education. Table 2 contains demographic frequencies for the full sample and reminiscence and health education groups. Mean age was similar between groups, 79.5 (SD = 6.26 years) and 78.8 (SD = 8.26 years), respectively, for the reminiscence and health education groups. Baseline pain intensity was moderate and pain interference with function was mild for both groups. Mean baseline reminiscence functions for positive, negative, and prosocial reminiscence were similar between the reminiscence and health education groups. Table 3 contains means and standard deviations for comparisons between groups.

Sample Demographics

Table 2:

Sample Demographics

Study Variables by Group

Table 3:

Study Variables by Group

The reminiscence and health education groups were compared for baseline differences using t tests and chi-square analyses. Reminiscence group baseline physical activity scores were significantly lower than the health education group (t[11] = 2.31, p < 0.04). Reminiscence group education level was also significantly lower than the health education group (χ2[2] = 6.10, p < 0.05). There were no significant group differences at baseline for pain intensity, pain interference with function, positive reminiscence, negative reminiscence, prosocial reminiscence, age, number of years with osteoarthritis, number of comorbidities, or body mass index. Group comparisons were not made for gender, race, or marital status because of the negligible baseline group differences.

Comparison of the reminiscence and health education groups for change in physical activity at or above the norm versus below the norm was not significant (χ2[2] = 2.13, p = 0.35). One reminiscence group participant changed from below the norm to above the norm from baseline to 3 months and one health education group participant changed from above the norm to below the norm. The remaining participants did not change their physical activity status from baseline to Month 3.

Comparison of the reminiscence and health education groups for change in pain interference with function was not significant (t[10] = 0.075, p = 0.94), reminiscence group mean change was 1.5 (SD = 3.84) and health education group mean change was 1.7 (SD = 3.00). Comparison of the reminiscence and health education groups for change in pain intensity was significantly worse for the reminiscence group (t[10] = 2.28, p < 0.05), with a mean change of 1.61 (SD = 1.89) for the reminiscence group and −0.72 (SD = 1.48) for the health education group.

Content analysis of feedback about the reminiscence sessions revealed that six participants identified positive comments and two participants identified negative comments. Only two participants provided comments about the effect of the sessions on their physical activity or pain. Participant 8 stated, “It helped to distract me from my pain. Being distracted made me want to go out more.” Participant 18 stated reminiscence “helped me to understand more about the pain, how to take care of it. I should exercise but am afraid of falling....”

Previously identified psychological benefits from facilitated reminiscence were described by participants. Participant 4 stated, “It helped me get a lot of stuff off my mind that has been bothering me for a while. I view things in a more positive way now, even the bad things were worth the time.” Participant 5 stated:

It makes me feel less alone because I started to talk with people more and I realize I am not alone. There is not much good to look forward to, so it's nice to think about the past in a positive way. Made me realize that life is all good in the end.

Participant 1 described reuniting with her estranged family, a psychological and behavioral benefit:

Talking about things that I have not thought about in years has helped me try to make myself better and has also inspired me to reach out to family members I have not talked to in years. I am grateful to have them in my life again.

Two participants identified negative outcomes. Participant 2 identified “too many of the questions focus on negativity, which does not make my life better.” Participant 14 identified that the reminiscence sessions “were not terribly helpful…just brought up negative memories.” Both participants had fewer reminiscences about physical activity, 14 and 21, respectively, than the remaining six participants. Both participants also had relatively few recreation-related reminiscences, with Participant 2 reminiscing more about health-related physical activity and Participant 14 reminiscing about work as much as recreation. Table 4 contains frequencies for reminiscence functions and type of physical activity (i.e., recreation, health, or work) for each reminiscence participant.

Reminiscence Functions Frequencies for Reminiscence About Physical Activity (N = 8)

Table 4:

Reminiscence Functions Frequencies for Reminiscence About Physical Activity (N = 8)

The majority of reminiscence was about recreation. Reminiscence was almost exclusively for conversation. Four participants also reminisced some of the time for self-regard. One participant reminisced to teach and inform on one occasion.

Discussion

Contrary to the hypothesis, older adults' reminiscences about past physical activity did not increase physical activity and instead increased pain intensity compared to older adults in the health education group. There was no significant difference in pain interference with activity. A temporary increase in physical activity might have exacerbated rather than ameliorated pain intensity if physical activity was too strenuous, inadequate, or inappropriate. Expert guidance from a physical therapist would assist older adults to identify safe, effective, feasible ways to increase physical activity tailored to individual physical abilities and interests. Future research testing use of reminiscence to increase physical activity should include expert guidance in physical activity specific to older adults. The significant group difference in pain could also be a spurious result from the small sample size.

Simple reminiscence, such as reminiscing for conversation about past physical activity, may be inadequate to spur older adults to increase physical activity in a sustained clinically meaningful way. Facilitated integrated reminiscence has been supported to affect psychological factors such as optimism and indirectly affect depressive symptoms (Pinquart & Forstmeier, 2012), but has not yet been supported to impact physical activity. It seems logical that if an older adult is depressed and facilitated reminiscence causes the older adult to become less depressed that increased physical activity could result. Depression and depressive symptoms are associated with decreased physical activity and increased sedentary activity (Hiles, Lamers, Milaneschi, & Penninx, 2017). However, substantial evidence supports a directional relationship such that increased physical activity reduces depressive symptoms (Cooney et al., 2013; Schuch et al., 2016).

Conversation emerged as the predominant reminiscence function during the sessions. Conversation is a prosocial reminiscence function and has not been associated with increased health (Cappeliez & O'Rourke, 2006). Guiding older adults beyond conversation to problem solving, a self-positive reminiscence function associated with health, could be crucial for promoting increased physical activity or other healthy physical behavior change through reminiscence. The self-positive reminiscence function is negatively associated with absence of well-being, and absence of well-being is associated with an increased number of comorbidities (Cappeliez & O'Rourke, 2006). Self-positive reminiscence functions, such as problem solving, therefore might positively impact health status via increased well-being.

The qualitative findings provide further insight into the impact of reminiscence about past physical activity for older adults with osteoarthritis pain. One woman identified that the reminiscence sessions helped her think about estranged family members. She reached out to her family and reunited with them as a result. Although the outcome was unrelated to physical activity, the benefit of talking about past family activities encouraged her to reconsider her estranged relationship. A second woman stated that the reminiscence helped distract her from her pain. As a result, she had more desire to interact socially; however, it remains unclear if she actually increased her social interactions. The benefits experienced by these two women might be possible for other individuals in similar circumstances. The unexpected benefits suggest that other outcomes should be routinely explored in future reminiscence research. Responses from two additional participants reinforced previous research about the outcome of increased optimism.

Two of the eight reminiscence group participants found the sessions unhelpful. Both participants had less reminiscence regarding physical activity. A critical level of past physical activity might be required to provide sufficient content for reminiscence. Screening for past physical activity might be necessary to identify individuals likely to benefit from reminiscence about physical activity.

Limitations

Study limitations indicate the need for cautious interpretation of the results. The current study was conducted as a pilot to test whether facilitated reminiscence would result in increased physical activity. The underlying premise that integrative reminiscence can elicit a physical outcome, such as increased physical activity, might be incorrect. To date, no reminiscence intervention has been directly linked with health other than psychological outcomes.

Reminiscence sessions were facilitated by trained research assistants, but the ability to facilitate reminiscence away from the function of conversation and toward self-positive functions, such as problem solving, might require greater skill, support, and reinforcement. For example, reminiscing about past physical activity might lead older adults to compare their past abilities with current decreased abilities to exercise. According to the Theory of Cognitive Adaptation (O'Rourke, 2002), the facilitator would use integrative reminiscence to identify coping and problem-solving skills to assist older adults to reframe their thinking about physical activity. Reminiscence sessions were monitored for a focus on reminiscence, but not for the type of reminiscence function used or the ability of the facilitator to facilitate integrative reminiscence. Future reminiscence interventions should monitor the type of reminiscence functions and encourage more positive self-function reminiscence. Closer monitoring of the reminiscence sessions and more frequent debriefing with facilitators are also recommended.

Physical activity was measured via self-report and might not reflect actual physical activity. Additional factors might impact the effect of reminiscence on physical activity and pain. For example, some older adults might have been debilitated from prolonged physical activity and unable to engage in increased physical activity without support from a physical therapist. Fear of falling and incurring serious injury might also deter older adults from increased physical activity. Time of the year might have impacted physical activity. Some participants began the study in January, February, and March, making walking outside less enjoyable or feasible. The limitations suggest areas to strengthen for future reminiscence research.

Conclusion

The current generation of older adults lived their childhood and adolescence prior to Title IX (U.S. Department of Justice, n.d.), the law that created gender equity in school sports and thus increased sport opportunities for women. All participants, but one, were women in the current study. Participants had much less organized sport activities to reminisce about, which might have reduced the effect of the reminiscence about physical activity. Future generations who engaged in organized sports activities might reminisce differently with different outcomes.

Reminiscence about past physical activities, whether play, leisure, sports, or work related, did not increase physical activity, but resulted in other beneficial outcomes for some older adults in the sample. Results from this pilot study inform the next step in reminiscence research to increase physical activity and decrease pain. The authors' next study will include: (a) more intensive training and monitoring of the reminiscence facilitators; (b) a more focused reminiscence session about past physical activity and problem-solving skills; (c) assessment of depressive symptoms; (d) a different length and number of sessions to optimize the intervention; and (e) a physical therapist to guide safe increases in physical activity. The Theory of Trialing to Pain Control indicates that individuals in pain need to work with their practitioner to identify and trial effective pain treatments until they gain control over their pain (McDonald, 2014). Refinement of the facilitated reminiscence intervention and greater fidelity to the theoretical underpinnings of Trialing to Pain Control (e.g., inclusion of a physical therapist) require further research. Tentative findings that reminiscence about past physical activity improved behavioral outcomes for two of eight participants suggests that facilitated reminiscence might be useful for improving other healthy behaviors.

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Reminiscence Session Topics/Questions

Topics
Tell me about your daily life as a child.
What chores did you do to help your parents?
What did you do for play as a child?
Tell me about the organized school sports that you took part in during your childhood.
Tell me about the physical activities that you enjoyed with your friends and family.
What special aspirations or dreams did you have for your life when you were younger? Did they come true? What did you do to make them come true?
Describe a time when you had to handle a difficult situation (death of a loved one, loss of job, illness). Tell me about how you coped with the difficult or painful situation. How did that experience make you a stronger person?
Tell me about the physical activities you have enjoyed as an adult.
Thinking about your physical activity over the years, describe turning points that changed the amount or type of your physical activity. How did you cope with these changes in the amount or type of physical activity?
How do you feel about growing older? How do you keep yourself healthy and active?
Describe your favorite memory involving a physical activity.
What are you most proud of in your life?

Sample Demographics

Variablen (%)
Total (N = 13)Reminiscence Group (n = 8)Health Education Group (n = 5)
Female12 (92.3)7 (87.5)5 (100)
White12 (92.3)8 (100)4 (80)a
Highest education
  Less than high school2 (15.4)2 (25)0 (0)
  High school6 (46.2)5 (62.5)1 (20)
  Associate degree1 (7.7)0 (0)1 (20)
  Bachelor's degree1 (7.7)0 (0)1 (20)
  Postgraduate degree3 (23.1)1 (12.5)2 (40)
Marital status
  Married1 (7.7)1 (12.5)0 (0)
  Widowed9 (69.2)5 (62.5)4 (80)
  Divorced2 (15.4)2 (25)0 (0)
  Single1 (7.7)0 (0)1 (20)

Study Variables by Group

VariableMean (SD)
BaselineMonth 1Month 3
ReminiscenceHealth EducationReminiscenceHealth EducationReminiscenceHealth Education
Physical activity70.1 (31.45)110.2 (28.68)68 (46.07)107.4 (45.84)83.9 (40.46)110.0 (53.32)
Pain intensity4.2 (1.71)5.0 (1.15)4.8 (1.58)3.6 (1.31)5.1 (1.96)4.2 (1.87)
Pain interference3.5 (2.30)2.9 (2.28)3.3 (2.39)3.6 (0.95)4.5 (2.82)4.6 (2.40)
Positive reminiscence40.5 (8.88)36.6 (8.62)37.3 (13.46)35.8 (10.62)41.8 (9.94)40.8 (9.04)
Negative reminiscence25.1 (6.29)27.4 (8.02)22.9 (8.95)24.4 (7.09)24.6 (6.89)24.2 (5.02)
Prosocial reminiscence16.4 (4.27)16.6 (3.13)15.0 (4.07)14.6 (1.67)14.0 (2.07)16.2 (2.17)
Age79.5 (6.26)78.8 (8.26)
Years with arthritis12.9 (11.96)23.2 (11.88)
Comorbidities3.1 (1.73)4.6 (1.95)
Body mass index (kg/m2)31.9 (8.43)27.6 (4.06)

Reminiscence Functions Frequencies for Reminiscence About Physical Activity (N = 8)

Participantn (%)
ConversationSelf-RegardTeach and Inform
RecreationHealthWorkRecreationHealthWorkRecreationHealthWork
17 (30.4)2 (8.7)12 (52.2)1 (4.3)0 (0)1 (4.3)0 (0)0 (0)0 (0)
26 (42.9)8 (57.1)0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
422 (62.9)3 (8.6)9 (25.7)0 (0)1 (2.9)0 (0)0 (0)0 (0)0 (0)
530 (61.2)3 (6.1)7 (14.3)9 (18.4)0 (0)0 (0)0 (0)0(0)0 (0)
820 (71.4)0 (0)5 (17.9)2 (7.1)0 (0)0 (0)1 (3.6)0 (0)0 (0)
148 (38.1)3 (14.3)8 (38.1)1 (4.8)1 (4.8)0 (0)0 (0)0 (0)0 (0)
1610 (29.4)1 (2.9)23 (67.6)0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
1817 (60.7)1 (3.6)10 (35.7)0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
Authors

Dr. Shellman is Associate Professor, and Dr. McDonald is Associate Professor, University of Connecticut School of Nursing, Storrs, Mr. Ferraro is Staff Nurse, Bachus Hospital, Norwich, and Ms. Milner is Staff Nurse, Hartford Hospital, Hartford, Connecticut.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank the University of Connecticut for funding the research through a Scholarship Facilitation grant, and Sigma Theta Tau Mu Chapter for providing additional research funding.

Address correspondence to Deborah Dillon McDonald, PhD, RN, Associate Professor, University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-4026; e-mail: deborah.mcdonald@uconn.edu.

Received: November 21, 2018
Accepted: February 27, 2019
Posted Online: June 03, 2019

10.3928/19404921-20190522-02

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