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Theme: CLAHRC - Healthy People, Healthy Environments
Being physically active is beneficial at all ages and can contribute to the prevention and management of many physical and mental health conditions. Compared to younger people, relatively few older people are active enough to meet Department of Health physical activity targets. Much research on this topic has been undertaken but it has not been brought together to provide a comprehensive picture.
This project involved conducting a systematic review of existing research evidence to try and understand older people’s (aged 50+) experiences and identify what is known to be effective in helping them participate in appropriate levels of physical activity in order to be healthy. Systematic review is a research technique that uses specific steps to ensure that all the relevant information on a topic is considered fairly and not treated in a biased way.
We looked at what people said (qualitative data) about the factors that help them stay physically active, and what might make this difficult. We also “mapped” the evidence from existing systematic reviews to see what was known about which interventions work to support people being physically active and to explore whether there are gaps in, for example, what has been studied, or the groups of people who have been included in such studies. It was important to see if the types of activities that have been studied reflect the experiences and preferences of older people themselves and the work of our patient and public involvement group was part of this process.
The aim was to provide information for policy makers and commissioners about which factors they need to think about when planning services that prevent or encourage physical activity. We have also identified where there are gaps and uncertainties in the existing evidence to allow researchers to target where more research is needed.
Review 1: What do older people think about physical activity? What helps them or prevents them from staying active?
Five overarching themes were identified that capture older people's experiences of physical activity:
Ageing body and "embodied" experiences - how people experience their physically active body as they get older. The review found that in some cases this is a positive experience such as finding dance empowering, while sometimes it is negative, such as a fear of pushing too hard and injuring themselves.
Life course - how activity and being "sporty" relates to people's sense of identity and how broader social factors influence active behaviour.
Sociability - the social aspects of exercise, such as organised groups and a sense of togetherness, are often important in motivating enjoyment and participation.
Walkability - for many people in the reviewed studies, walking was the priority physical activity and was linked with a sense of belonging to the community. For frailer people, walking was still important and accessibility and safety were key issues.
Health literacy - some people were unsure if their health conditions would benefit or worsen as a result of exercise, so tended to avoid it.
Review 2: What interventions exist to increase older people's physical activity, and do they work?
Many studies in this review supported using interventions to increase physical activity for older people, but there was a lack of detail about what form these interventions should take and how to measure their success. Using walking interventions, pedometers and motivational strategies appeared to be effective.
Mapping of reviews 1 and 2: Do the interventions being used map on to older people's needs?
Walking was an important theme in both reviews, with some of the interventions focussing on group walking and others encouraging challenges using pedometers. However, the interventions in review 2 mostly emphasised individual motivations, while review 1 indicated that the social aspects of activity are important for older people. There was limited evidence from either review about policy or environmental factors that might encourage activity.
Three dissemination meetings have been held with members of the public, public health and other policy makers and practitioners such as physiotherapists, to share the project findings and discuss the wider context of the research, as well as the types of output that could be useful.
The project findings are also being shared with other researchers: Dr Orr presented the qualitative evidence synthesis findings at an Ageing and Society conference in Sweden in October 2016.
The mapping review results were presented at the International Environmental Epidemiology Society in Rome in September 2016 by Dr Sharpe, and at the International Conference of Behavioural Medicine in Melbourne in December 2016, by Dr Smith.
You can hear more about this project and it's finding in our podcast:
This project was led by Dr Ruth Garside at the European Centre for Environment and Human Health (ECEHH). You can also read about the study on the ECEHH website.
Garside R, Phoenix C, Sharpe R, Orr N, Bethel A. What are the factors that influence older adults’ engagement in exercise and physical activity? An evidence synthesis of qualitative research and mapping of quantitative reviews. PROSPERO, 2015.
Phoenix C & Orr N. Analysing exceptions within qualitative data: promoting analytical diversity to advance knowledge of ageing and physical activity. Qualitative Research in Sport, Exercise and Health, 2017
Dr Richard Sharpe, Advanced Public Health Practitioner in Public Health Cornwall & Associate Research Fellow with University of Exeter Medical School; Dr Cassie Phoenix, European Centre for Environment and Human Health