Physical activity and healthy ageing : a mixed methods study of the factors influencing older people's physical activity decisions and behaviours

Despite the many health benefits that accrue from regular participation in physical activity up to 50 percent of people over 65 years of age are reported to be inadequately physically active to realise these benefits. The aim in the present thesis was to use a mixed methods approach to better understand the complex array of environmental, social and individual factors that contribute to older people's physical activity behaviours. This approach enabled the refinement of a health action model that depicted these factors and their likely associations and the exploration of ways in which physical activity might be encouraged and supported in this population. Two hundred and twenty three participants (82 ± 7 years old) from six residential locations in Northern Tasmania completed a physical activity survey that assessed their level of physical activity, their perceptions of activity and the degree of social support for activity they received. Twenty people were selected for face-to-face interviews to explore in-depth the complex phenomenon of ageing and physical activity. Survey results indicated that the percentage of inadequately physically active participants was significantly lower than reported in the extant literature. This finding raises important questions about the way in which older people's activity levels are currently assessed. Interest in, perceived importance and utility of physical activity were high and positively associated with activity level, while the perceived amount of effort it took to be active was negatively associated with activity level. The least active quartile of survey participants reported significantly higher effort associated with being active. Thematic analysis of interview data revealed the main barriers to activity to be injury or illness, a lack of competence and lack of time. Interviewees described their main motivations as being the support of enthusiastic others, being fully engaged in activities and having fun while being active. A refined health action model is posited based on the survey and interview findings which, by providing greater insight into the factors influencing physical activity behaviours, supported the redistribution of barriers and motivators from a single factor to individual and specific factors. Enhanced social engagement positively influences multiple factors within the model and presents an important intervention point for changing people's behaviours. The findings from the present thesis suggest that to increase participation by older people in regular physical activity exercise and health professionals need to utilise techniques that promote and support engagement. Theories such as adult play and reversal theory provide insights into how activity leaders might maximise engagement and enable participants to experience the arousal associated with activities as challenging, exciting and safe and to overcome anxieties associated with a fear of failure or fear of injury. Finally, techniques such as motivational interviewing and acceptance and commitment therapy can be incorporated into discussions around physical activity to resolve ambivalence and explore opportunities for self-managed change.