Life in the Fourth Age has been typified as a time of continued functional decline and reduced quality of life. Exercise might positively affect this experience. This study explored the exercise experiences of nursing home residents age 86–99 years who participated in a 6-month exercise intervention. An interpretive phenomeno-logical approach was adopted. Twenty-one interviews were held with 14 residents at baseline and 7 residents at follow-up. Although their expectations were initially conservative, by the end of the intervention participants noted improved quality of life through better mobility, decreased fear of falling, and feelings of achievement and success. They valued the program as an opportunity to do something for themselves, to add something to their weekly routine, to meet other people, and to be more active generally. The professionalism of the exercise instructor appears to have been critical, balancing principles of safe and effective practice with the need to ensure that participants had fun in a supportive environment.
Afroditi Stathi and Piers Simey
Afroditi Stathi and Simon J. Sebire
Inner-city schools experience substantial difficulties in providing sufficient physical activity opportunities for their pupils. This study evaluated the Y-Active, an outreach physical activity and well-being program delivered in an inner-city primary school in London, UK by a third-sector partner.
A process evaluation focusing on perceived effectiveness and implementation issues was conducted using qualitative case-study methodology. Semistructured interviews and focus groups were conducted with Year 5 and Year 6 pupils (N = 17, age range = 9 to 11 years), Y-Active sports leaders (N = 4), the school head teacher, class teachers (N = 2), and the Y-Active administrator. Transcripts were thematically analyzed and multiple informant and analyst triangulation performed.
The Y-Active leaders created a positive learning environment supporting autonomy, balancing discipline and structure and providing self-referenced feedback, excellence in tuition and a strong focus on fun and praise. Pupils reported improvements in self-confidence and competence, self-discipline and interpersonal relationships. School staff and Y-Active leaders highlighted that their partnership was built on trust, top-down leadership support and open lines of communication between the provider and the school.
Collaboration between third sector service providers and inner-city schools represents a promising means of increasing children’s physical activity and well-being.
Jolanthe de Koning, Suzanne Richards, and Afroditi Stathi
This cross-sectional, observational study examined whether objectively measured physical activity (PA) and specific activities are associated with loneliness and social isolation (SI) in rural-living older adults. A total of 112 participants (M age = 72.8 [SD = 6.6], 51.8% female) from 23 villages in Wiltshire, United Kingdom, completed questionnaires, 7-day accelerometry, and activity diaries. Regression analysis was used to test associations between objectively measured light PA, moderate to vigorous PA, and total PA; loneliness; and SI from family, neighbors, or friends and to explore these associations using specific activities. Daily mean light, moderate to vigorous, and total PA were not associated with loneliness or SI. Volunteering, accompanying others, and sports/exercise were associated with lower SI from neighbors (odds ratio = 0.23, 95% CI [0.06, 0.91]), family (odds ratio = 0.39, 95% CI [0.22, 0.68]), and friends (odds ratio = 0.56, 95% CI [0.33, 0.97]), respectively. There were no associations between loneliness, SI, and objectively measured PA. The contribution of PA to loneliness and SI needs to be further investigated with larger and diverse samples of rural-living older adults.
Jolanthe L. de Koning, Afroditi Stathi, and Kenneth R. Fox
The frequency of trips outdoors is a strong indicator of older adults’ physical activity levels. This qualitative study compared and contrasted determinants of trips outdoors between rural- (n = 13) and urban-living (n = 15) people aged 65 and older living in England. Interview transcripts were analyzed through directed and summative content analysis employing the Ecological Model framework. Some personal-level determinants (age-related barriers) and environment-level factors (car dependence, bus services) were shared across samples. The main differences were seen in how a community-based social network instigated trips outdoors for rural participants while family ties mostly led to trips outdoors for urban-living participants. Urban participants used and valued recreational facilities, but rural participants did not report them as important in determining trips outdoors. Strategies to improve public transport and minimize age-related barriers may translate from urban to rural contexts. However, social and/or physical environment interventions could be more effective if they were rural-grounded, not urban-translated.
Cecilie Thøgersen-Ntoumani, Nikos Ntoumanis, Hannah Uren, Afroditi Stathi, Catrina Wold, and Keith D. Hill
The aim of the current study was to explore perceptions of group-based walking and gather suggestions to inform the development of a group-based walking intervention among older adults in retirement villages. Twenty-four physically inactive residents (16 female, 8 male; age range: 69–88) and four managers from four retirement villages were interviewed. Inductive thematic analysis revealed six broad themes: lack of motivation, values versus constraints, fears and confidence, need for structure, creating a sense of belonging, and the physical environment as a double-edged sword. Proposed intervention strategies included using trained walk leaders, using small groups, planning for flexibility, setting attainable goals, creating a routine, creating opportunities for sharing experiences, and planning a variety of walks. Group-based walking programs may be used to promote physical activity but careful planning of such programs is needed to make them appealing and feasible to a diverse group of residents.
Mark G. Davis, Kenneth R. Fox, Afroditi Stathi, Tanya Trayers, Janice L. Thompson, and Ashley R. Cooper
The relationship of objectively measured sedentary time (ST), frequency of breaks in ST, and lower extremity function (LEF) was investigated in a diverse sample aged ≥ 70 years (n = 217). Physical activity (PA) was assessed by accelerometry deriving moderate-vigorous PA (MVPA) minutes per registered hour (MVPA min · hr−1), registered ST (ST min · hr−1), and breaks in ST min · hr−1 (breaks · hr−1). LEF was assessed by the Short Physical Performance Battery. Univariate associations with overall LEF were MVPA (r = .523), ST (r = −.499), and breaks (r = .389). Adjusted linear regression including MVPA min · hr−1, ST min · hr−1, and breaks · hr−1 explained 41.5% of LEF variance. Each additional break · hr−1 was associated with 0.58 point increase in LEF. Breaks and MVPA had strongest independent associations with LEF. Promoting regular breaks might be useful in maintaining or increasing LEF and later life independence. This novel finding is important for the design of effective lifestyle interventions targeting older adults.
Afroditi Stathi, Holly Gilbert, Kenneth R. Fox, Jo Coulson, Mark Davis, and Janice L. Thompson
This mixed-methods study investigated personal, interpersonal, and environmental factors salient to decisions about being active in neighborhoods of different levels of deprivation.
Twenty-five participants age 70 years and older (10 women) with diverse physical activity levels provided data on their weekly activity patterns (using accelerometry) and their perceived barriers to exercise (questionnaire). They also participated in semistructured individual interviews exploring the barriers and facilitators influencing neighborhood activity.
Functional limitations, lack of intrinsic motivation, and not having an activity companion were the highest impact barriers. Walkable access to amenities, positive physical activity perceptions, and existing habit of being active were the highest impact facilitators.
The perceived quality and accessibility of the built and natural environments influence neighborhood activity in older adults. However, this relationship might be altered through the influence of personal and interpersonal determinants such as maintenance of good health and functional ability and supportive social networks.
Marlene Kritz, Cecilie Thøgersen-Ntoumani, Barbara Mullan, Afroditi Stathi, and Nikos Ntoumanis
The authors examined whether purposeful walking with peers at least once a week contributes to better behavioral and health outcomes in older adults than primarily walking alone. The authors used a longitudinal cohort design and recruited participants aged 60 years and older (N = 136) at the start of a 16-week walking intervention. Participants who walked on average at least once a week in the final 8 weeks of the intervention were included in the analysis (N = 79; 66 females, M age [SD] = 77.73 [6.91]). The authors found that autonomous motivation, walking self-efficacy, functional capacity, body fat, and physical activity improved more in the walking with peers group compared with the walking alone group, after controlling for whether participants lived alone/with others and their health status. The results extend current literature by providing longitudinal evidence for the added benefits of regular peer-accompanied walking in older adults and highlight the importance of investing in peer-supported interventions.
Tanya Trayers, Debbie A. Lawlor, Kenneth R. Fox, Jo Coulson, Mark Davis, Afroditi Stathi, and Tim Peters
Associations of objectively measured physical activity (PA) with objectively measured lower limb function in adults age 70 and older were studied. Lower limb function was assessed using the Short Physical Performance Battery (SPPB) and PA by an accelerometer providing mean daily counts per minute (CPM), mean daily steps and minutes of moderate or vigorous PA (MVPA) per day. A minority (32 [13%]) scored low (≤6 out of a maximum of 12) on the SPPB, but only 3 (1%) achieved recommended PA levels. Adjusting for confounders, the odds ratio of low SPPB (≤6) comparing those in the lowest one third to highest two thirds of mean CPM was 55 (95%CI: 6, 520); for mean steps per day it was 23 (95%CI: 4, 137) and for minutes of MVPA per day 56 (95%CI: 6, 530). Low levels of PA are common and are associated with poor levels of lower limb function in older adults.