National physical activity recommendations for older Australians: Discussion Document

5.2 Societal influences

The National Ageing Research Institute was commissioned by The Department of Health and Ageing to review the evidence and develop physical activity recommendations for older people.

Page last updated: 01 February 2011

Both generational and secular influences can shape physical activity patterns. The current generation of older Australians are influenced by historical perceptions about the appropriateness of physical activity behaviour in older people. The current generation of older people were exposed to a physically active lifestyle, but where the activity was related to occupational and domestic tasks, rather than to active leisure pursuits or sports engagement. There is a viewpoint that sedentary behaviour is part of growing old. Decreasing sedentary behaviour amongst older people is critical, particularly for the current generation where the adage that ‘old age is for resting’ still tends to prevail. Many cohort studies have shown the strong inverse association between physical activity behaviour and age, independent of actual health status (Armstrong, Bauman et al. 2000; Semanik 2002). Whilst expectations are changing and being challenged by media campaigns, the older generation and society at large have not wholly embraced the health promotion message that physical activity is useful at any age. This issue is particularly pertinent with regard to older women: society has tended to view physical activity, at least in the form of ‘exercise’ as more male-oriented behaviour. Ageist stereotypes can impact adversely on older people’s behaviour, not least physical activity behaviour. This topic has been discussed in a comprehensive commentary paper (Ory, Kinney Hoffman et al. 2003). The authors highlighted a range of strategies to address ageism and promote healthy living, including: education, particularly training for care providers, media campaigns, intergenerational programs and alterations to the built environment.

The concept of self-presentation is pertinent to physical activity behaviour in older people. Self presentation is the monitoring and control of how one is seen by others. There is evidence that older people are sensitive to health and ageing changes that may make them be perceived as dependent or inept. This may lead them to pursue physical activity in order to be viewed more positively. Alternatively, their self perception may be linked to beliefs that it is inappropriate for older people to be seen exercising, producing the opposite effect (Martin, Sinden et al. 2000).

Nor can we rely upon early active lifestyle patterns being sustained into older age. Older people both commence and cease being physically active for a range of reasons. Indeed, the inter-generational association for physical activity behaviour is relatively weak at around 0.3 (National Centre for Health Statistics 1999).

One possible reason for giving up physical activity may be the person’s limited exposure to different physical activity types. For instance, responses from older women (65-97 years old) highlighted that most respondents had only experienced one type of physical activity (Conn, Minor et al. 2003). It can be hypothesised that over time, the initial enthusiasm for and benefits from one type of physical activity may wane. Encouraging older people to consider a varied ‘diet’ of physical activity, meeting a range of biopsychosocial needs, may be helpful. Additional factors including socio-economic status and costs associated with physical activity participation (not just costs of the physical activity program itself, but hidden costs such as clothing, runners, and other equipment) can also influence initial and longer term participation.
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There is acknowledgement that one’s social and physical surroundings can influence behaviour patterns. To influence the social milieu, there have been a wealth of health education campaigns promoting physical activity in Australia. A specific campaign targeted older people during 1999, the International Year of Ageing. In their review of different approaches to increase physical activity, Kahn et al. (2002) provided examples of informational interventions, social support in community settings and an environmental and policy intervention to illustrate the various options for promoting physical activity beyond the individual level. The first two are outlined below and the third is discussed in Section 5.3.

The informational interventions included use of staircase promotion signs, an approach that is applicable to all age groups, although it may not be suitable for older people with mobility impairment. The signage would need to be supported by access to safe, well-lit staircases to have optimal effect.

Community-wide campaigns are effective in increasing physical activity behaviour (Kahn, Ramsey et al. 2002). They entail multifaceted, comprehensive, highly visible strategies. Apart from the NSW media campaign evaluation (Bauman, Armstrong et al. 2003), there has been limited analyses of the specific impact of such campaigns on older people’s behaviour. One recent example comes from a longitudinal study of two US communities, who were surveyed at baseline, 3, 6 and 12 months. In this quasi-experimental design study, the ‘intervention’ community was targeted using paid advertisements, public relations, and community participatory planning. These strategies significantly raised awareness and achieved sustained changes in physical activity amongst sedentary older people (50-65 year olds) (Reger-Nash, Bauman et al. 2005).

Social support - from peers, family and friends – contributes to the uptake of physical activity, but its relative impact has yet to be fully determined. Mentoring and buddy schemes, telephone reminders and incentives have been used, but methodological weaknesses limit the interpretation of the studies’ findings (National Centre for Health Statistics 1999). The social support model was used in nine studies reviewed by Kahn et al, mainly with middle aged populations (Kahn, Ramsey et al. 2002). The common aim of these models is to establish and maintain strong social networks to encourage social relationships that will engender behaviour change. Typically, a buddy system operates, with people ‘contracted’ with one another to achieve physical activity targets through companionship. The ‘Walk and Talk’ programs in Australia are an example of this model. In the US, a two year study focused on older, postmenopausal women (50-65 years old) in walking groups and found good levels of compliance with the three miles three times per week schedule (Kriska, Bayles et al. 1986). Physical activity was monitored by self report and using Caltrac™ activity monitors. The relative impact of self monitoring, phone prompts and incentives was not reported.

The social capital literature provides level IV evidence of an association between social capital and health status. There is some evidence about physical activity in adults per se, but influences amongst the older adult population require greater assessment. It can be hypothesised that communities where social cohesion and connectedness are greater are more likely to provide an environment that promotes physical activity. Such neighbourhoods are more likely to be viewed as safe to walk in. There is more likely to be support to engage in physical activity, be it from an active neighbour or significant other. There will be places to go for physical activity, both indoors and outdoors. The importance of environmental factors is discussed further in Section 5.3.
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Aboriginal and Torres Strait Islanders

There is limited information concerning the knowledge, attitudes and beliefs of individual Aboriginal and Torres Strait Islanders about physical activity, but we can glean some evidence from representative organisations. In their submission to the National Physical Activity for Health Action Plan, the Bidgerdii Aboriginal and Torres Strait Islanders Corporation Community Health Service Central Queensland Region emphasised the importance of an inclusive approach to physical activity promotion (Fredericks 2004) :

‘ All people need to be able to access a range of activities, from older Aboriginal and Torres Strait Islander people… people with a disability’ (pg 10).

They were particularly supportive of flexibility exercises, given the need to address the needs of the mobility impaired older members of their community. They endorsed the use of group and community-based activities for not only the traditional health benefits but also for ‘enjoyment, challenge, self-expression and social interaction’ (pg 10).

For Aboriginal and Torres Strait Islanders, strategies that incorporate extended families, use role models and highlight connectedness to the land have been suggested (National Aboriginal Community Controlled Health Organisation 2005). As with other groups, older Aboriginal and Torres Strait Islanders are more likely to participate in physical activity when there are pleasant surroundings and opportunities for social interaction (National Physical Activity Program Committee 2001).

People from CLDB populations

There is ample evidence on the barriers and facilitators to physical activity participation in older people, but less about influences amongst CLDB older people (Eyler, Brownson et al. 1999). Differences may be found between migrants with differing immigration histories. Researchers note that cultural differences may also be confounded by socio-economic status, since many migrant communities are socio-economically disadvantaged. People from CLDB and non-CLDB groups have reported common barriers to physical activity adoption: access restrictions due to costly programs and limited transport thereto, and unsafe environs, but the CLDB groups have noted the adverse effect of culturally inappropriate programs (Seefeldt, Malina et al. 2002). There is very limited information about variations in the perception of physical activity behaviour and its relative value across cultures (Eyler, Brownson et al. 1999). In addition, some differences may be found between migrants with differing immigration histories.

Women from Italian, Anglo-Celtic and Vietnamese communities in Melbourne (Bird, Kurowski et al. 2005) participated in a survey and focus groups to discuss their participation in physical activity and their physical environment. The findings highlighted the common importance of access to recreational facilities, the aesthetic features of activity venues, access to neighbourhood cycle and walking trails. Similar to other studies, fear of crime was identified as a barrier and positive aesthetics as an enabler of physical activity across all the CLDB groups. A broader study, with people from the Macedonian, Greek, Indian, Maltese and Serbian communities has commenced, including geographic mapping techniques.

Further research to address these gaps in the evidence base should be a priority.
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