Physiological Benefits Of Physical Activity Health And Social Care Essay

Introduction

Over the past 25 years, the UK has seen an increase in individuals aged 65 yrs and over. In 2009, it was reported by the Office of National Statistics (2010) that the population aged 65 and over increased from 15% in 1984 to 16% in 2009, which is an increase of 1.7 million people. They predict that by year 2034 23% of the population is projected to be aged 65 and over compared to 18% aged 16 and under. The fact that people are living longer is associated with healthy ‘active living’, over the past 10 years health has steadily improved (ONS, 2004). It is reported that older adults who are physically active report a ‘greater satisfaction’ in life (Weinberg & Gould, 2007) this is due to retaining mobility and keeping their quality of life and independence (Chaudhury & Shelton, 2010). In 2008, the Department of Health (2010) reported that 39% of men and 29% of women aged 16 and over met the government’s recommendations for physical activity, this was compared with 32% of men and 21% of women in 1997. However, evidence suggests that with an increase of age there is a decrease in levels of physical activity regardless of the well publicised benefits of the association with good health and well being (Berger, Der, Mutrie & Hannah, 2005). Retirement can be a key time to focus on physical activity and well being. It is a time where people can review many areas of their life, including their health. People make preparations for retirement in different ways but research shows that very little preparations are made for health promoting physical activity (Chaudhury & Shelton, 2010). As the older adult population is rising, maintaining a healthy life is a growing public concern (Acree, 2006) in year 2002, physical inactivity was reported to cost £8.2 billion a year (NHS, 2008).

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A recent study by Chaudhury & Shelton (2010) formed the basis of this study, the paper explains the data analysis from the Health Survey for England (HSfE) in 2006 and 2007 which focused on physical activity participation amongst 60 to 69 year olds and knowledge of the physical participation requirement. The study highlighted that older adults had unrealistic views of their perceived activity levels and reported that there was a lack of knowledge regarding the recommended physical activity guidelines. They examined the perceived barriers to physical activity participation and reported that barriers such as work and lack of time prevented them taking part in exercise. From the study they concluded that there needs to be more focus on health promotion and education particularly in the over sixties. In order to promote healthy living firstly, we need to understand why physical activity decreases with age. The purpose of this study is to explore the attitudes and behaviours towards physical activity with particular focus on 60- 69 year old. A qualitative study will provide the basis of this study. Qualitative methods offer the opportunity to explore an individual’s experiences, perceptions, motives and barriers to physical activity (Thomas, Nelson & Silverman, 2005). In addition, this study will review other studies which have been carried out associated with physical activity around retirement.

Aim

The aim of this study is to explore the attitudes and behaviours towards physical activity in people aged 60 – 69 years focusing on continuity and change around the time of retirement.

Objectives

1. To explore knowledge of physical activity recommendations and attitudes to participation

2. To research continuity and change in levels of physical activity at retirement

3. To describe perceptions of sufficiency of own physical activity behaviour

4. Explore the perceived barriers to meeting governments recommended levels of physical activity, before and after retirement.

Analysis from the data obtained from the interviews can be used to provide recommendations towards improving the transition to retirement in terms of achieving health promoting physical activity levels.

Limitations

There are limitations regarding the sample size and reliability of the information. The sample size was small and levels of activity were what participants perceived as being enough exercise however despite this the literature was consistent with our findings.

Literature Review

Physiological benefits of Physical Activity

According to World Health Organisation (2010) globally, physical inactivity contributes to 1.9 million deaths per year and is currently the fourth leading risk factor for all deaths. It has been well publicised that regular physical activity has a huge influence on promoting good health and psychological well being and is associated with the reduction of risk factors for chronic health problems such as cardiovascular diseases, type 2 diabetes and obesity (Martinez del Castillo et al, 1997; Sjogren & Stjernberg, 2010). Physical activity can be defined as “any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level” (WHO, 2010) and has a range of health benefits which can be achieved through sport and exercise or activities such as walking, cycling, gardening and housework (Department of Health, 2010). Although the aging process is vulnerable to a wide range of conditions such as hypertension, back pain, osteoporosis and some cancer’s studies have shown that physical activity can reduce these and can increase life expectancy and improve bone and muscle strength (Berger et al, 2005). Stewart et al (2003) examined a group of older sedentary adults and reported that physical activity was evidently associated with a reduction of bodily pain and that small amounts of regular physical activity was associated with better quality of life. King et al, (2000) studied physical activity and physical functioning in 103 adults aged 65 yrs and over using moderate-intensity endurance and strengthening exercises and stretching and flexibility exercises. The study reported significant improvements to quality of life and mobility. Research supports the theory that exercise enhances quality of life (QOL). Berger (2009) explains that QOL is ‘a broad construct that reflects a person’s perception of his or her own position in life in relation to personal goals, standards, and expectations within the context of culture and value systems in which the individual lives’. Therefore the relationship between exercise and QOL may be influenced by an individual’s own perceptions and values. Chaudhury and Shelton (2010) explain that by maintaining independent living is the key. Improving balance and co ordination can help prevent injury from trips or falls. Cassell (2002) recommended physical activity to be the ‘best treatment for aging’.

Psychological Factors and Physical activity

Brassington et al (2002) explains that the strongest determinant for physical activity participation for older adults is self efficacy or confidence. If a person enjoys what they are doing they are more likely to participate in it. Physical activity can be encouraged by many factors and older adults tend to look at physical activity as how it is going to benefit them. For example if I exercise I will lose weight or if I exercise and remain fit I will be able to play with the grand children. There are many theories which can be applied to health behaviours which we will look at later on in this paper. Participation is preserved through enjoyment and social support from friends and family. One study (Cooper & Thomas, 2002) used ballroom dancing as a way of keeping fit and were physically challenged by using different styles of dancing to suit the persons skills. Dancing encouraged social networks which supported participation across major life events such as loss of a spouse or friend through support from other dancer’s .Having a social network or living with a partner has found to have a positive influence on physical activity participation (Bruce, 2002). Regular exercise can help preserve independence (Sparling et al, 2000) it can increase feeling of self worth, increase self efficacy and reduce feelings of feeling reliant family members (Chaudhury & Shelton, 2010). Research suggests that the health benefits of physical activity and exercise are now well established. In 2010 the World Health Organisation reported that by 2020 depression will follow cardiovascular disease as the world’s leading cause of death and disability. Psychological disorders such as depression are commonly treated by medication or by taking part in therapy sessions however, more people are now looking at physical activity as a way of dealing with feelings of depression (Weinberg & Gould, 2007).

Barriers to Physical Activity

The benefit and the barriers to physical activity are significant for behaviour change and it’s important that in order to increase participation that we understanding the barriers that older adults face. The Health Survey for England (2008) reported that 41% of men and 43% of women reported lack of time as the main barrier to exercise many older people may have caring responsibilities or may be involved in voluntary work and use lack of time for a reason not to exercise (BHF, 2010). Barriers can be classified into two groups these are intrinsic or extrinsic. Intrinsic barriers are based on an individual’s belief, previous experience or self efficacy. Brassington et al (2002) explains that the strongest determinant for physical activity participation for older adults is self efficacy or confidence. Many older adults have the fear of not been able to keep up with the class or not wanting to attend the class alone. They may be conscious of their body image and fear for lack of changing facilities. Extrinsic barriers refer to the environment for example; concerns for safety older adults may be concerned about slippery pool side surfaces, ageism, or skills of teachers (BHF, 2010). Overcoming these barriers is paramount in promoting health and independence and by taking part in regular physical activity will in turn help prevent ill health and disability. Those who understand the benefits to exercise will have fewer barriers than those who are not aware of the benefits to physical activity and those who have several barriers will have low perceived benefits. It is important that people are educated of the benefits to physical activity.

Socio-economic status and physical activity

Research has looked at how physical activity can be influenced, factors that have been found to be most significant amongst older adults include education, social class, participation earlier in life, social support and opportunity factors (Bird, 2009). Martinez del Castillo et al, (2005) examined the participation rates of physical activity between social classes and reported that there was a positive relationship between social classes. The results found that the percentage of those physically active were – Upper class =38.2%, middle class =18.5%, lower class= 9.7%. The relationship was found with their present income; those who had adequate income participated in physical activity and those that didn’t did not want to participate. Overall, the lower the social status the less old adult participation in physical activity. Those who had encouragement from a partner or a social network who wanted to take part in physical activity took part. This is not to say that people from lower classes would be exempt but local opportunities and encouragement may contribute to leading healthy lifestyle (Martinez del Castillo et al, 2005). Lower classes do not always get the same opportunities, the higher someone’s socio economic status the greater the opportunities (Berger et al, 2005). Those amongst lower socio economic groups, health has always been an issue and suggests education and health promotion focusing on low income communities (Peterson et al, 2006). The Whitehall study (2004) of British Civil Servants explored the relationship between work, retirement and physical activity. They found that different occupational grades affected health. Those in a lower employment grade had a higher mortality rate compared to those in higher grades. Physical activity was least regular with those working full time compared to those working part time or not at all. This would suggest that those working part time or not at all would have more time to exercise. Interestingly, after retirement those who worked full time were found not to increase their levels of activity however, those who worked part time or not at all did. The frequency of physical activity amongst the different occupational grades was found to be higher with more sport and gardening done by higher occupational grades (Mein et al, 2005). Sjogren & Stjernberg (2010) found that having access to areas for country walks, parks and recreational centres are the most important factors for influencing outdoor activity. Education is an important predictor of older adult physical activity; women with a low level of education compared to women with a higher level, those with a higher level were more likely to take part in physical activity. Mortality rates are lower amongst those who become physically active later in life compared to those who may have been active earlier in life but now have a sedentary lifestyle (Sjogren & Stjernberg, 2010). Arguably, Berger et al, (2005) reported that education, car and deprivation were not strong predictors of whether someone regularly takes part in physical activity instead other lifestyle factors such as not smoking and healthy diet were strong predictors.

Continuity and Change

Continuity and change plays an important role in the transition to retirement, whilst retirement is seen as a time of leisure, studies have shown that only a small amount of people make changes to their leisure activities after retirement (Nimrod, 2007). Atchley (1989) explains that the Continuity Theory is considered a key feature of post retirement leisure, the theory ‘holds that, in making adaptive choices, middle-aged and older adults attempt to preserve and maintain existing internal and external structures; and they prefer to accomplish this objective by using strategies tied to their past experiences of themselves and their social world. Change is linked to the person’s perceived past, producing continuity in inner psychological characteristics as well as in social behaviour and in social circumstances. Continuity is thus a grand adaptive strategy that is promoted by both individual preference and social approval.’ In recent study Nimrod (2007), explored the adaptation process to retirement, particularly changes in behaviour and the psychological benefits. The study involved examining four different groups of people (1) expanders-those who report participation in a greater amount of activities at a higher frequency, (2) reducers-those who reported participation in the same or in fewer activities at the same or at a lower frequency, (3) concentrators-those who report participation in the same, or in fewer activities, but at a higher frequency, and (4) diffusers-people who report participation in a larger number of activities but at the same or at a lower frequency. Interviews were carried out using four different questionnaires. Their finding supported the Continuity Theory that people did not tend to engage in any new leisure activities after retirement they simply spent more time participating in the activities they were involved in pre retirement. Participation in activities in early life promotes participation later in life (Martinez del Castillo et al, 2005).

Government guidelines and initiatives

The recommendation for how much physical activity is required has changed over the years (Berger et al, 2005). The Chief Medical Officer for England set a target that by 2020 70% of the UK population will be reasonably active (Allender, Cowburn & Foster, 2006). The current recommendation for physical activity is at least 30 minutes of moderate intensity activity, 5 days per week to improve health and quality of life, this can be built up in bouts of 10 minutes or more (Berger et al, 2005; Allender et al, 2006; Berger, 2009; WHO, 2010). Moderate intensity could include activities such as gardening, swimming, house work or home improvements, the intensity should correspond to that of a brisk walk (Berger et al, 2005; NHS, 2010). Short bouts of exercise are more tolerable and more enjoyable than long or high intensity exercise (Wilson, Yilla & Soloman, 2001). The issue is not being able to get people to exercise it is encouraging people to adhere to exercise (Byrne & Byrne, 1993). In a report by the Department of Health (2001) the National Institute of Clinical Excellence (NICE) recommended a programme for patients suffering from depression using ‘structured, supervised exercise, three times a week for 45 minutes to 1 hour for 10 to 12 weeks.’ The programmes were rolled out through exercise referral schemes. In 2006 NICE reviewed the scheme and found that there was insufficient evidence. This was due to patients not maintaining the physical activity they had been prescribed as they found leisure facilities and gyms intimidating and adherence levels dropped. If patients are to adhere to exercise long term it needs to be an activity that they enjoy. National and local policies aim to promote independence and mobility, prevent ill health disease and disability and prevent accidents amongst older people. The following government initiatives are currently available;

Free swimming for the over sixties

Let’s get moving’ Physical activity care pathway programme.

Chief medical officer report ‘at least 5 per day’

Choosing physical activity – an action plan

Heidelberg guidelines for promoting physical activity amongst older people

Sport England Sport playing its part

Policy on sustainable walking

Policy on sustainable cycling

The government is always looking for ways to promote physical activity. Theories are used in assisting with promoting health behaviours.

Transtheoretical Theory and Physical Activity

Over the years there has been an increasing need for more theory driven research in health behaviour change. There have been many theories developed to help understand changes to health behaiviour for example The Social Cognitive Theory (Bandura, 1977) and the Transtheoretical Model (Prochaska & DiClemente, 1984) which is one of the most widely adopted models in health promotion. The components of the Transtheoretical Model that have been applied to exercise are stage of change, processes of change, decisional balance, self-efficacy, and temptation to not exercise. Stage of change refers to a person’s readiness to engage in regular exercise. Pre contemplation is the stage where someone does not take part in any physical activity and is not planning to start within the next 6 months. Thee contemplation stage is where someone is considering taking part in physical activity within the next 6 months, someone may stay in the contemplation stage as long as 2 years but may never move from this stage. Someone in the preparation stage may have already started to exercise but nothing regular but they have taken the first steps to start. The Action stage describes someone who has been exercing for less than 6 months. This is the most unreliable stage and there is a possibility of relapse. The Maintenance stage describes someone who has been exercising for 6 months or more. It is likely that once reaching this stage that someone will continue to exercise and it becomes part of their daily routine. It is important to identify what stage a person is at before putting strategies in place to promote physical activity (Sparling, 2000). The Social Cognitive Theory (Bandura, 1977)

Methodology

To meet the aims and objectives of this study, qualitative research methods were used to obtain information. ‘Qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomenon in terms of the meanings people bring to them. It involves the studied use and collection of a variety of empirical materials (e.g., life story, interviews, etc.) that describe routine and problematic moments and meanings in individual’s lives’ (Denzin & Lincoln, 1998). Qualitative methods aim to explore and individuals experiences, perceptions, motives and barriers (Thomas & Nelson, 1996). It is inductive which enables a theory to be developed following the collection of the data. There are three different types of interviews – Structured; usually with a structured questionnaire, Semi structured; Open ended questions, and un-structured; Questions are based on what the interviewee says (Britten, 1995).

For the purpose of this study a face to face semi-structured interview was conducted in November 2011 and took place at the respondents’ homes situated in the North West England. The study was based 2 female retirees aged between 60yrs and 69yrs who retired during the past five years. Open questions were asked during the interview regarding: Previous occupation(s), leisure time activities, reasons for retirement, knowledge of physical activity and participation in physical activity. Interviews lasted between 30 and 45 minutes.

Interviews were arranged by telephone. 15 women were asked if they would consider participating in the study. 2 women volunteered. Interviews were arranged at a time convenient for the participants. They were advised that no costs would be involved and were notified that the benefits for taking part in the study were that they will receive information relating to physical activity and details of the current government recommended guidelines.

Sampling Criteria

Consideration was applied as to who could be purposively selected for this study. Participants were recruited from a local women’s group. The inclusion criteria were they should be aged between 60 – 69 years, working to retirement or retired within the last 5 years. Exclusion criteria included; history of psychiatric illness including depression, history of neurological illness or history of heart disease.

Interviews were arranged by telephone. 15 women were asked if they would consider participating in the study. 2 women volunteered. Interviews were arranged at a time convenient for the participants. They were advised that no costs would be involved and were notified that the benefits for taking part in the study were that they will receive information relating to physical activity and details of the current government recommended guidelines.

Ethical Issues

Prior to this research commencing ethical approval was obtained by the University. An information sheet and a consent form was prepared and handed to the participants 24 hours prior to the interview. This enabled the participants to ask questions and to give consent prior to the interviews commencing. Participants were advised that interviews would be recorded and that all information from the interview would be kept confidential. They were free to withdraw from the study without reason at any time and that any data would be destroyed.

Data Analysis

Following the interview the interviews were transcribed

Results and Discussion

In general, both participants considered themselves to be physically active whilst at work. P1and P2 had occupations within a shop setting where they did alot of lifting and carrying. P1 worked in a florist and P2 in a supermarket both participants explained that they enjoyed their jobs but as they became older they found it difficult to be as active at work as much as they had been.

P1 explains; “….ill health caused me to say enough is enough because I was working 16 / 17 hours per day because we were so busy.”

P2 explains; “….I did a lot of lifting in my job that is one of the reasons why I came off the job, I had to do a lot of kneeling, it was causing me a lot of pain on my knees….”

Both participants explained that they still wanted to be active but natural ageing caused them to ‘slow down’. P2 expanded on this and went onto say that in the 8 years building up to retirement she helped out in a children’s nursery, helping wash up, answering the door. After retiring from the florist she still felt that she needed to keep busy. Whilst being active in the workplace I how far participants lived away from their work and how they used to get there. P1 explained that although she only lived 5 minutes away she would drive to work. This was because she would start at 4am by attending the markets to buy the flowers for the shop and generally would not finish until 6 or 7 o clock in the evening. Deliveries would also need to be done during the day so she needed the car. P2 also drove to work however she would sometimes walk depending on the time of the shift. P2 explained that if it was evening she would definitely drive. When asked the reasons for walking whether it was to enable her to keep fit. P2 explained that it never crossed her mind that it was exercise and that it was doing good, she did it because she fancied a walk and wanted some fresh air. Their understanding of sport and physical activity was fairly accurate. It was explained that sport was something that you took part in, went out and played. Where physical activity was explained as a hobby something that was pleasurable. Physical activity does not have to be competitive. Many studies only examine leisure activities, it’s important that if we are to encourage healthy living that Simple housework, home improvements or going for a brisk walk are included in the daily accumulation of physical activity. When asked about what leisure activities they participated in before they retired

P1 explained; “I can’t say I had a lot of time when I came home from the shop, apart from cooking and baking, going for a walk, going to football match, things like that, holidays they’re all classed as activities aren’t they…”

P2 explained;”Leisure time was a non entity, no such thing as leisure time, because I had a home and a family to look after so there wasn’t really time for any leisure time, the only time was perhaps later in an evening where you would perhaps sit down and watch the television for a couple of hours before you went to bed at night.”

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This highlights the barriers, lack of time being the primary reason for not exercising this corresponds with the English National survey where lack of time was reported as the main reason and most frequently reported barrier for not taking part in exercise. Women typically find it difficult to find time to exercise due to the demands of a family, household jobs and work, they rarely have time for themselves. Making physical activity part of your daily routine encourages physical participation throughout the life course which enhances both mental and physical well being. Those who participate in physical activity throughout their life are more likely to continue this later on in life (Castillo et al, 2005; Berger et al, 2005).P2 explained that she had never participated in any sport throughout her life as it was just not something that she was interested in.

P2 explained… “Because im just not a sporty type of person… im more into… delving in history, that’s my past time, which does not require much physical exertion..” . As highlighted previously exercise does not need to include sport activities but moderate intensity exercise such as going for a brisk walk, gardening or housework are all types of exercise.

P1 explained “I am a crown green bowler, I was the president for the North Lancs and Fylde, I was the captain of the county…”

When asked if this was something she had away’s taken participated in. P1 explained that her husband who has only just recently passed away was also a bowler this influenced her to participate in this past time together. Castilo et al, (2005); Bruce, (2002) identified that having a social network, including living with a partner encouraged participation. Both participants retired at retirement age because it was the right time, so they could start to sit back and enjoy life. Both participants could afford to retire and decided it was ready to ‘enjoy’ life. This supports the theory that a person’s socio-economic position continues to influence on post-retirement activities (Scherger, Nazroo & Higgs, 2010).

P1 explained”…When I turned 60 he said come on let’s spend some time together, life’s too short and you don’t realise, you think you have years so I said right I will do so I did..”

P2 explained “It was retirement age and I just felt it was the right time for me to retire, id had enough of working life I just wanted to get out the rat race of working, cause I wasn’t really enjoying my job at that time. I can afford to retire so that’s what I am going to do and enjoy life a bit..”

People make preparations for retirement in different ways but research shows that very little preparations are made for health promoting physical activity (Chaudhury & Shelton, 2010). When asked about how they would consider keeping fit and healthy in retirement,

P1 explained; “Never crossed my mind, I knew I would still always be doing, I knew I still did things. I bowl even more now, even in the winter I do indoor bowling…”

P2 explained; “No, I knew I would go for walks, I have a garden at home, I have a grandson who id be running round after…”

Participants were asked about their knowledge of the government guidelines for physical activity. Research suggests that very few people know how much exercise is required. P1 and P2 responses correspond with this.

P1 replied “….Well I wouldn’t know what it was but I would imagine there was one…”

P2 replied “….no…”

Participation in activities appears to be based on enjoyment and social networks (Allender et al, 2006) I asked P2 the main reasons for participating in bowling now whether it was for the fitness or more the social aspects?

P1 replied “…Both really, meeting people, social side of things…”

Chaudhury & Skelton (2010) stated that those not in work reported more physical activity at home or during leisure time compared to when in employment. When asked if they thought they were more active now or before they retired both participants said that they thought they were more active now

P1 explained”…. yes I would say now….”

P2 explained “…. I would say I have more now….”

Berger et al, (2005) outlined that if a person is considerably active during employment that activity is not always replaced after retirement. The study found that people in work were more likely to meet the daily levels of exercise required than in retirement. Physical activity should be measured in other activities to ensure the recommended daily levels of activity are met.

P2 added that she also does volunteer work at the local church. Van Willigen

(2000) reported that older people who worked as a volunteer experienced positive changes in perceived health and experienced an increase in life satisfaction

Both participants were aware of local activities aimed at the over 60’s however, both stated that they perceived that took part in enough activities to meet the daily target of 30 minutes per day.

People make preparations for retirement in different ways but research shows that very little preparations are made for health promoting physical activity (Chaudhury & Shelton, 2010).

Conclusion

The aim of this study was to explore the behaviours and attitudes to physical activity around retirement age. My findings are show that there are clear variations of older adult physical activity from sport related activities to general leisure time. Studies have shown to examine formal activities but there is li