Perceived health and motivation to physical activity in seniors

section social sciences

kontakt 16 (2014) e44–e50

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Original research article

Perceived health and motivation to physical activity in seniors Jiří Mudrák *, Pavel Slepička, Irena Slepičková Charles University in Prague, Faculty of Physical Education and Sport, Department of Pedagogy, Psychology, and Didactics, Psychological Laboratory, Czech Republic

article info

abstract

Article history:

In the present study, we examined the physical activity, and the perceived health and related

Received 18 February 2013

motivational constructs in Czech older adults. It is a correlational questionnaire study con-

Accepted 25 October 2013

ducted in a sample of 315 Czech seniors, mostly participants of various educational and social

Available online 31 January 2014

programmes for older adults. We administered a battery of questionnaires to measure selfrated physical activity (PASE, LTEQ), perceived health (SF-12) and motivation to physical

Keywords:

activity (scales of perceived self-efficacy, social support and self-regulation strategies).

Seniors

We found a significant relationship between physical activity and perceived physical and

Ageing

mental health. Considering the motivational constructs, we found a significant relationship

Physical activity

between physical activity and perceived self-efficacy and social support. On the other hand,

Health

we found a weaker relationship between physical activity and explicit motivational strate-

Motivation

gies, such as planning, goal-setting and self-regulation. The results may indicate that the physical activity of our respondents is predominantly habitual. They probably do not focus on exercise itself but the physical activity may be a byproduct of other activities. This is supported also by the fact that the indicated physical activity of respondents stemmed mostly from everyday activities, such as walking, gardening or working around the house. # 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Introduction Psychosocial aspects of health in specific sub-populations, such as older adults, still remain a relatively unexplored area in the current literature. However, as the age structure of the developed countries changes, the topics of healthy ageing and the motivation of older adults to health-related behaviour demand increasing research attention. At present, the rapid ageing of the European population becomes an important focus of biomedical as well as social sciences. The number of research studies will undoubtedly continue to grow as it is

expected that the number of people over 60 years old will rise steadily, surpassing one billion seniors worldwide in 2020. Also the population of the Czech Republic is getting older; seniors encompass more than 18% of the Czech population and this proportion is also expected to rise. Current demographic trends suggest that over 30% of Czech adults will be over 60 years old in 2050. We may expect that this development will have psychological and social impacts on the whole Czech society. Considering the demographic development that is expected to take place in the next few decades, it is not surprising that the topic of ageing becomes the centre of

* Corresponding author at: Charles University in Prague, Faculty of Physical Education and Sport, Department of Pedagogy, Psychology, and Didactics, Psychological Laboratory, José Martího 31, 160 00 Prague 6, Czech Republic. E-mail address: [email protected] (J. Mudrák). 1212-4117/$ – see front matter # 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved. http://dx.doi.org/10.1016/j.kontakt.2013.10.001

kontakt 16 (2014) e44–e50

attention not only in sciences but also for national and international government bodies and institutions. For example, the Czech Republic has created ‘‘the national programme of preparation for ageing for 2008–2012’’. One of the main goals of this programme is to create conditions that will help to maintain and possibly also increase the quality of life of older adults after they make the transition from the ‘‘active’’ phase of their life towards retirement. This programme is based on an assumption that the growth of the quality of life in older age and successful overcoming age-related changes is determined by the active lifestyle of the senior population and the factors related to that lifestyle, such as a senior-friendly environment and community, quality healthcare in older age, the social support of family and care-givers, or opportunities for being actively involved in the community. Therefore, one of the most important research tasks is to further facilitate an understanding of the factors related to the quality of life in older age and to apply this knowledge in increasing the length of active life and systematically preparing people for the latter phases of their ontogenetic development. It is especially important also that in this phase of life older people should engage in a lifestyle that allows them to satisfy all their needs. The topic of active lifestyle has been explored by various biomedical and social sciences. These sciences include kinanthropology which focuses, above all, on physical activity as an important aspect of active lifestyle encompassing both biomedical and social perspectives. In this context, various studies [1–4] have emphasized the positive impact of systematic physical activity on physical and psychological health. From a psychological point of view, physical activity can be conceptualized as an interactional process co-creating the life of an individual; active sporting physical activity represents an aspect of the lifestyle positively influencing the quality of life. ‘‘Active lifestyle’’ is a lifestyle which integrates physical activity into a normal everyday regime, including various physical activities corresponding to the actual needs of an individual. It is generally agreed that sporting physical activity is beneficial for long-term physical independence, mitigates the age-related physical decline and increases the quality of life. However, sporting physical activity in older adults should not be considered only on the basis of its physical effects as it is related to the personality as a whole, including its psychosocial dimension. In general, sporting physical activity enhances the emotional life, and positively influences cognitive processes as well as psychological endurance. The social context of physical activity is especially important in the older population [3]. Social communication necessary for the participation in physical activity supports the fulfilment of the social needs and helps overcome the feelings of social isolation and loneliness that are often present in the senior population [5]. Therefore, the psychosocial effects of sporting physical activity and the related active lifestyle help maintain a good quality of life till old age. Although it is universally agreed that physical activity positively influences the psychological life in all developmental phases, systematic research focusing on the effect of active sport participation on psychological health in older adults is still not sufficient. The question of the relationships between values, motivational factors and active sport participation is

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especially important. Above all, it is of interest how motivation influences physical activity and how participation in physical activity impacts objective and subjective health in older adults. It is important to note that subjective perception of one's own health which includes how people evaluate and experience their health status is not necessarily the same as objective health. Therefore, in the present study we focused on the examination of motivational sources that support physical activity in the population of older adults, how older adults subjectively perceive their health status, and what the role of their physical activities is in this perception.

Materials and methods Participants 315 adults over 60 years old participated in the study. The respondents actively participated in social and educational activities aimed at the senior population; they attended senior clubs, universities of the third age, and other social activities for seniors. They were approached through these institutions and asked to fill a questionnaire. We distributed 600 questionnaires; therefore, the response rate was 52.5%. The average age of respondents was 67.8 years, 92% were retired, 82.6% were women, 57.1% completed high school and 34% completed a university education. Their average BMI index was 26.5. Their places of residence were the capital city of Prague, regional capitals (Plzeň, Brno) and a district town (Uherské Hradiště).

Measures We used the following scales in the study: The Leisure Time Exercise Questionnaire, the Physical Activity Survey for the Elderly, SF-12: A 12-Item Short-Form Health Survey, and a battery of motivational scales, supplemented by a set of demographic items. All scales used have been standardized for research on older adults. For the purpose of our study the questionnaires were translated from English by a professional translator, revised by the authors of the study and backtranslated by another professional translator to verify the accuracy of the translation. The quality of the back-translation (i.e. the similarity between both English versions) was evaluated by a native speaker, an expert in the field of health psychology who uses the original versions of the scales in her research.

The Leisure Time Exercise Questionnaire (LTEQ) LTEQ questionnaire has been used as the main method of measuring participation in physical activity. The LTEQ measures the self-reported average weekly amount of physical activity over the period of the last four weeks at four intensity levels (strenuous, moderate, light and the time spent sitting). Above all, The LTEQ questionnaire measures the physical activity performed during free time. LTEQ is considered a valid and reliable instrument for measuring leisure-time physical activity and has been used previously with older adults [6].

Physical Activity Survey for the Elderly (PASE) The PASE questionnaire has been used as a supplement to the LTEQ questionnaire. Its main objective was, above all, to record

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what kinds of activities the respondents participated in and how they evaluated the intensity of these activities. The PASE is a ten-item questionnaire and it records levels of physical activity in various domains and also types of physical activity and their perceived intensity as performed in the past week. Compared to LTEQ, it covers a broader range of physical activities focusing also on physical activity in work and household and was designed specifically for older adults. PASE is considered a valid instrument for measuring physical activity in older adults [7].

Motivation scales As a measure of motivation we used several questionnaires covering a range of social cognitive motivational constructs. We used the following scales: Lifestyle Physical Activity SelfEfficacy (LSE) [8] assessing the level of confidence that sufficient physical activity will be a part of one's lifestyle during the following six months; Barriers Self-Efficacy (BASE) [9] measuring the belief in one's capacity to overcome various barriers of physical activity; Exercise Planning and Scheduling Scale (EPS) and Exercise Goal-Setting Scale (EGS) [10] assessing motivational strategies such as planning and goal setting; Social Support for Exercise (SSE) [11] that captures perceived social support in physical activity from friends and family, and Physical Activity Self-Regulation (PASR) measuring a range of motivational constructs related to self-regulation [12].

SF-12: a 12-Item Short-Form Health Survey As the method for measuring health-related quality of life we used the 12-item questionnaire SF-12 [13]. This questionnaire focuses on self-evaluation of one's health, perceived health limits, or physical, emotional, and social aspects of one's health. The SF-12 questionnaire provides scores of perceived psychological health and physical health. It represents a valid and reliable method of health evaluation frequently used in the research on older adults [13].

Data analysis Descriptive statistics (frequency tables, mean, median, standard deviation) has been used as the main method of sample description, including the types and duration of physical activities and various aspects of perceived health. Correlational analysis (Spearman correlation coefficient) was used to assess the degree of relationship between physical activity, perceived health and motivation constructs. Also, the types of physical activities were assessed by a qualitative content analysis. The results were processed in SPSS 19.0 software.

Results

Table 1 – Portion of physically active/non-active participants.

Non-active Active Valid Missing Total

The results of the LTEQ questionnaire show that the participation in physical activity in our sample is relatively high; 43.9% of the respondents stated that they met the levels of physical activity recommended by the World Health Organization (i.e. at least 150 min of moderate physical activity or 75 min of vigorous physical activity per week). On the other

%

Valid %

138 134 272 43 315

43.8 42.5 86.3 13.7 100.0

50.7 49.3 100.0

hand, 74.6% of the respondents stated that they did not participate in any vigorous physical activity, although most of them stated that they did participate in moderate physical activity; 61% of the respondents participated in moderate physical activity at least occasionally (see Table 1). Considering the type of physical activity the respondents participated in, it is important to note that the major source of physical activity was of a non-sporting character. Although the respondents mentioned also a number of sporting activities, they participated predominantly in walking, gardening and working around the household (at the light level of physical activity), gardening and working around the household (at the moderate level of physical activity) and swimming and bicycling (at the vigorous level of physical activity).

Perceived health Most of the respondents experienced some objective health problems–more than 80% had an objective diagnosis and had taken medication. However, subjectively they perceived their health positively. More than 70% of the respondents evaluated their health as at least good and only 2.4% evaluated their health as poor (see Table 2).

Physical activity and perceived health In the second part of the study we focused on the relationship between physical activity and perceived physical and mental health. We found a significant relationship between both aspects of perceived health and leisure physical activity measured by the LTEQ questionnaire (r = 0.268 in physical health and r = 0.231 in mental health). On the other hand, a lower degree of relationship has been found between perceived health and overall physical activity as measured by the PASE questionnaire. The results emphasize, above all, the positive health-effect of leisure physical activity (see Table 3).

Table 2 – Perceived health. Perceive health as

Physical activity

N

Excellent Very good Good Fair Poor Valid Missing Total

N

%

4 51 152 75 7 289 29 315

1.3 16.0 47.8 23.6 2.2 90.9 9.1 100.0

Valid % Cumulative % 1.4 17.6 52.6 26.0 2.4 100.0

1.4 19.0 71.6 97.6 100.0

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Table 3 – Correlations between physical activity and perceived health.

Table 4 – Correlations between physical activity and lifestyle physical activity self-efficacy.

Spearman rho

Spearman rho

Physical health

Mental health

0.117* 0.038 313

0.024 0.667 313

0.268** 0.000 274

0.231** 0.000 274

PASE Correlation coefficient Sig. (2-tailed) N LTEQ Correlation coefficient Sig. (2-tailed) N LTEQ Intensive p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Moderate p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Light p.a. Correlation coefficient Sig. (2-tailed) N

0.225* 0.018 109

0.239** 0.001 182

0.004 0.949 253

0.316** 0.001 109

0.059 0.428 182

0.129* 0.040 253

Note: significant correlations in bold. * p = 0.05. ** p = 0.001.

PASE Correlation coefficient Sig. (2-tailed) N LTEQ Correlation coefficient Sig. (2-tailed) N LTEQ Intensive p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Moderate p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Light p.a. Correlation coefficient Sig. (2-tailed) N

Lifestyle physical activity self-efficacy

Barriers physical activity self-efficacy

0.288** 0.000 270

0.220** 0.000 264

0.302** 0.000 244

0.170** 0.008 239

0.058 0.565 101

0.191 0.060 97

0.305** 0.000 166

0.058 0.466 166

0.307** 0.000 228

0.155* 0.021 222

Note: significant correlations in bold. p = 0.05. ** p = 0.001. *

Motivation to physical activity We found that the participation in physical activity was related to some motivational constructs but it showed generally low correlations with explicit motivational strategies related to self-regulation. The strongest relationship has been found between both scales of physical activity and self-efficacy beliefs related to the overcoming barriers of physical activity and self-efficacy beliefs related to physical activity as a part of the lifestyle (see Table 4). We found also a significant relationship between both physical activity scales and perceived social support. This relationship was strongest at the moderate intensity level of physical activity (see Table 5). On the other hand, there was only a low degree of relationship between both scales of physical activity and explicit self-regulation strategies. In the EPS and EGS scales we found a significant relationship only between physical activity and the quality of goal setting practices but not in exercise planning and exercise prioritizing (see Table 6). Also, the self-regulation strategies measured by the PASR questionnaire showed a significant relationship only with overall physical activity measured by PASE but an almost nonexistent relationship with leisure physical activity measured by LTEQ (see Table 7).

Discussion

Table 5 – Correlations between physical activity and perceived social support. Spearman rho PASE Correlation coefficient Sig. (2-tailed) N LTEQ Correlation coefficient Sig. (2-tailed) N LTEQ Intensive p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Moderate p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Light p.a. Correlation coefficient Sig. (2-tailed) N

SSE Family

0.196** 0.003 236

0.134* 0.038 242

0.173* 0.012 209

0.185** 0.007 215

0.121 0.281 81

0.131 0.239 83

0.131 0.121 142

0.234** 0.004 147

0.044 0.541 196

0.035 0.619 201

Note: significant correlations in bold. p = 0.05. ** p = 0.001. *

The observed relationship between self-rated physical activity and the measured motivational constructs illustrated, above

SSE Friends

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Table 6 – Correlation between physical activity and exercise planning and scheduling (EGS and EPS scales). Spearman rho

PASE Correlation coefficient Sig. (2-tailed) N LTEQ Correlation coefficient Sig. (2-tailed) N LTEQ Intensive p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Moderate p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Light p.a. Correlation coefficient Sig. (2-tailed) N

Exercise prioritizing

Exercise planning

Quality of goal setting practices

0.004 0.947 257

0.081 0.195 261

0.197** 0.002 256

0.088 0.185 231

0.105 0.108 236

0.134* 0.040 234

0.154 0.139 94

0.074 0.475 96

0.038 0.715 95

0.165* 0.036 161

0.046 0.560 165

0.163* 0.039 161

0.018 0.795 217

–0.011 0.874 221

0.003 0.966 219

Note: significant correlations in bold. p = 0.05. ** p = 0.001. *

all, the ways in which our respondents approached their physical activity. We found the most significant relationship between physical activity and physical activity self-efficacy. Perceived physical activity represents a belief about a personal capability to master an activity which is implicitly related to previous experience with the activity; the indicated level of perceived self-efficacy reflects, above all, to what extent a person participated in sports in the past. Therefore, we may argue that the most significant motivational/demotivating factor influencing the respondents' participation in physical activity represents their past engagement in physical activity. We also observed a significant relationship between physical activity and social support, i.e. whether other people valued the respondents' participation in physical activity, exercised with them, encouraged them and so on. It seems that support from other people plays an important role in the physical activity of older adults and they should have this support available in order to meet the levels of physical activity necessary for healthy ageing. It is interesting that explicit motivational strategies, such as planning, goal setting or self-regulation showed a relatively low relationship with physical activity in comparison with perceived self-efficacy and social support. Furthermore, these motivational strategies showed a stronger relationship with overall physical activity and almost no relationship with leisure physical activity. These findings suggest that the participation in physical activity in our respondents is predominantly habitual, i.e. their main focus is not on the physical activity as such but on other benefits which stem from the physical activity. This was reflected also in the indicated types of physical activity; the respondents

Table 7 – Correlation between physical activity and self-regulation (PASR scale). Spearman rho PASE Correlation coefficient Sig. (2-tailed) N LTEQ Correlation coefficient Sig. (2-tailed) N LTEQ Intensive p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Moderate p.a. Correlation coefficient Sig. (2-tailed) N LTEQ Light p.a. Correlation coefficient Sig. (2-tailed) N

Self-monitoring

Goal setting

Seeking social support

Self-reinforcement

Time management

0.163** 0.007 268

0.240** 0.000 275

0.187** 0.002 267

0.170** 0.005 277

0.182** 0.003 272

0.139* 0.031 240

0.061 0.342 247

0.059 0.360 239

0.070 0.271 247

0.075 0.247 243

0.105 0.300 99

0.019 0.847 103

0.017 0.870 98

–0.033 0.741 103

0.018 0.862 101

0.053 0.497 164

0.022 0.776 169

0.052 0.504 166

0.020 0.793 168

0.034 0.665 167

0.046 0.491 224

0.038 0.562 229

0.013 0.847 223

0.018 0.783 230

0.042 0.526 227

Note: significant correlations in bold. p = 0.05. ** p = 0.001. *

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predominantly stated that they participated mostly in workrelated activities rather than leisure sport activities. These results suggest that sport is not the principal source of physical activity in Czech seniors. Also, Czech seniors apparently do not use explicit motivational strategies, such as planning, goal setting or various self-regulation strategies as facilitators of their physical activity but they are motivated more by their previous experiences with physical activity or by perceived social support. However, the fact that some Czech seniors do not participate in sufficient physical activity may be caused also by factors other than the lack of motivation. As shown for example by Slepičková et al. [4] or Slepička and Slepičková [14,15], the reason that some older adults do not participate in sufficient physical activity does not result from their lack of motivation but it may be a result of insufficient opportunities. The majority of older people participating in these studies stated that they were interested in physical activity, had enough free time and would welcome more opportunities to participate in sports. As the main barrier of their participation in physical activity they perceived insufficient social support and, above all, insufficient availability of appropriate sport programmes which would suit their needs and health limitations. The results of our research also support the findings of other studies [16–20] which suggest a relationship between physical activity and optimal functioning in older age. Our study does not allow the assessment of the direction of causality and it is just as probable that healthier people participate in more physical activity as the other way around. Even so, it is obvious that physical activity is a part of a healthy lifestyle and the ways in which people perceive their health is related to their level of physical activity. In this context it is interesting that perceived health correlated significantly more with physical leisure activity as measured by the LTEQ questionnaire than with overall physical activity as measured by the PASE questionnaire. This suggests that leisure sporting physical activity is important for preserving health in older age. Also other studies have come to similar conclusions. For example, Li et al. [21] found that moderate physical activity (tai chi) led after 24 weeks of participation to significant improvements in perceived health. Fox [16] presents an extensive overview of experimental studies which shows that regular physical activity in older adults has therapeutic effects in lighter forms of depression and anxiety, improves the resilience to stress and positively influences the quality of sleep. Also Warburton et al. [22] present an overview of experimental studies which suggest that regular physical activity leads to a lower incidence of osteoporosis and diabetes. Similarly Ruuskanen and Ruopilla [23] found in physically active older Finnish adults that they perceived their health as better and experienced less depression than their physically less active peers. Considering the level of physical activity of our respondents, we may conclude that their physical activity is relatively high: almost 50% of our respondents met the levels recommended by the World Health Organization [24] which is more than in other similar studies. For example, Cavill et al. [25] found that about two-thirds of the European senior population do not meet the recommended levels of physical activity. On the other hand, another Czech study [26] found similar levels

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of physical activity in the participating seniors as we did (for example, 52% of their sample met the recommended levels of moderate physical activity). It is necessary to mention some limits of our study which stem from the methods used and the research sample. Our research sample consisted of older adults participating in educational programmes and it is obvious that this sample differs from the general population of Czech seniors. For example, in comparison to a representative sample of older adults [26] our sample included a higher portion of women and people with high school and university education. However, educational programmes for older adults provide an important source of physical activity for a large number of Czech older adults and provide health-related information to this group of people which influences their overall lifestyle. Therefore, we consider it important to research the participants of these programmes and look for the ways that may improve their life conditions. Another limitation stems from the methods used. The questionnaires used (SF-12, LTEQ, PASE) capture only a subjective evaluation of one's health or physical activity and their results may differ from objective measures such as medical examinations or pedometers. Nevertheless, we believe that these methods bring useful information. For example, a subjective evaluation of physical activity may better reflect the exerted effort than objective measures and in this way better capture the relative levels of individual respondents. Also, perceived health is an important component of subjective well-being and an important predictor of objective health status [27]. Finally, some of the results, especially the results pertaining to the relationship between physical activity and perceived health, or physical activity and motivation, have been obtained by correlational analysis which does not allow us to decide the direction of causality. Therefore, we do not know how these variables influence each other; we may however expect that this relationship is reciprocal.

Conclusion We found in this study that the physical activity of older adults was significantly related to their perceived health; this relationship was strongest in vigorous physical activity. The main motivation factor significantly related to physical activity included perceived self-efficacy and social support, but a less significant relationship was observed in explicit motivational strategies such as planning, goal setting and selfregulation. It seems that the participants were less motivated by the physical activity itself and their physical activity stemmed more from other goals, for example those related to work. On the basis of these findings we may conclude that Czech older adults should get more opportunities to participate in physical activity for example through specialized sport programmes designed to meet their specific needs. These programmes should also focus on the development of explicit motivational strategies in participating older adults that may facilitate their ability to overcome barriers to regular participation in sporting physical activity.

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Conflict of interest [12]

No conflict of interest. [13]

Acknowledgements [14]

The article has been written with the support of the research grant VZ MŠMT ČR MSM 0021620864 and in the framework of the scientific branch development programme UK FTVS n. 39 Social-Sciences Aspects of Human Movement Studies.

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