The identification of barriers to physical activity and exercise has been used for many decades to explain exercise behavior in older adults. Typically health concerns are the number one barrier to participation. Data from CCHS-HA dataset
The world’s population is aging. In 2009, 14% of Canada’s 32 million people were aged 65 years or older. This proportion is expected to rise to between 23 and 25% by 2036; effectively doubling the number of seniors observed in 2009 [
The sizeable proportion of inactive individuals forces a critical examination of the unique challenges faced by older adults, aimed at developing the most effective health strategies to promote physical activity in this cohort [
Typically, issues contributing to the lack of participation are elicited through the use of focus group discussions [
The majority of older adults do, however, identify at least one of these considerations. In the cohort studied by O’Neill and Reid [
The goal of the current study was to identify the relationship, if any, between what older adults perceived as barriers to physical activity and participation. Because previous research has suggested that health concerns pose a significant barrier to participation and would thus likely skew the data towards health-related barriers, we chose to focus on a subset of older adults who reported having no health condition limitation, illness, or injury that prevented them from participating in physical activity. We further delineated the analyses by gender as it has been well documented that older women tend to report more chronic diseases than men and this difference may impact overall participation rates [
Data from the Canadian Community Health Survey-Healthy Aging (CCHS-HA) (Statistics Canada, [
For the purposes of our study, we only used responses from the CCHS-HA dataset for people aged 60 years and older (
This was determined using the derived variable for participation in leisure physical activities. This categorical variable indicated whether the respondent had participated in walking for pleasure or exercise, light sports, moderate sports, strenuous sports, and exercises to increase muscle strength and endurance over the 7 days prior to the interview. It was scored as either a “1” indicating reported participation over the last 7 days, a “2” indicating no participation over the last 7 days, or a “9” indicating at least one required activity had not been responded to (these were excluded from future analyses). To confirm differences in participation, the PASE (Physical Activity for the Elderly Scale) score was also examined [
Thirteen barriers to participation were listed in the CCHS-HA dataset: cost, transportation problem, not available in area, location not physically accessible, location is too far, health condition limitation, illness or injury, fear of injury, lack of time, lack of energy, lack of motivation, lack of skills or knowledge, other. Similar to the participation measure, these were categorical variables where respondents indicated that “yes” it prevented participation, or “no” it did not prevent participation. Of these thirteen variables, ten were used to predict participation. Health condition limitation, illness or injury were used only to identify the current sample, and “other” was not included as it was not possible to draw a conclusion about illness, or injury from this response. The total number of barriers was derived (range: 0–8 barriers; mean =
Respondents were asked “In general, would you say your health is” excellent, very good, good, fair, poor. This categorical variable was recoded such that excellent and very good were collapsed together, and fair and poor were collapsed together leaving three levels of self-reported health status.
The CCHS-HA included a number of self-reported chronic condition variables that were coded categorically. The following seven were used in the current study: (1) vision function—this variable was derived from five items based on the respondent’s ability and/or inability to see well enough to read newsprint and be able and/or unable to recognize a friend on the other side of the street, with and/or without glasses or contact lenses. This resulted in three vision categories: no vision problems, problems corrected by lenses, and problems not corrected by lenses. No vision problems and corrected vision were collapsed together resulting in the two categories of no vision problems and vision problems; (2) heart disease—if the respondents reported having either angina or a heart attack, they were considered to have heart disease; (3) chronic obstructive pulmonary disease (COPD)—if the respondent reported having been diagnosed with chronic bronchitis, emphysema, or COPD, which yielded a broad category used to describe limitations in lung airflow; (4) diabetes; (5) osteoporosis; (6) living with the effects of a stroke—this was used to reflect neurological damage; (7) mobility trouble—this variable was derived from five items based on the respondent’s ability to walk a short distance and/or around their neighborhood, with and/or without the assistance of another person and/or walking equipment and/or a wheelchair. This resulted in four mobility categories: no mobility problems, mobility problems—no assistance required; mobility problems—requires wheelchair; mobility problems—requires help/cannot walk. The mobility problems were collapsed together resulting in two mobility categories.
Logistic regression techniques were used to examine the relationships between nonparticipation and barriers to participation, self-reported health status, and the seven chronic health conditions. Data were analyzed separately for male and female respondents. Odds ratios and 95% confidence intervals were used to identify the risk of nonparticipation as a function of the predictor variables. Due to the small sample size of nonparticipants (
Table
Sample descriptive statistics (weighted sample).
Variable | Category |
|
% |
---|---|---|---|
Participation | Participant | 4438 | 90.60 |
Nonparticipant | 459 | 9.40 | |
| |||
PASE | Participant | 142.99 | |
Nonparticipant | 139.68 | ||
| |||
Gender | Male | 2180 | 44.50 |
Female | 2717 | 55.50 | |
| |||
Excellent/very good | 2944 | 60.10 | |
Participant | 2715 | 61.2 | |
Nonparticipant | 226 | 49.2 | |
Good | 1491 | 30.40 | |
Self-reported health status | Participant | 1320 | 29.7 |
Nonparticipant | 171 | 37.3 | |
Fair/Poor | 465 | 9.50 | |
Participant | 404 | 9.1 | |
Nonparticipant | 62 | 13.5 | |
| |||
Vision function | |||
Yes | 66 | 1.40 | |
No | 4806 | 98.60 | |
Heart disease | |||
Yes | 2212 | 45.20 | |
No | 2676 | 54.80 | |
COPD | |||
Yes | 231 | 4.70 | |
No | 4664 | 95.30 | |
Diabetes | |||
Chronic health conditions | Yes | 595 | 12.10 |
No | 4303 | 87.90 | |
Osteoporosis | |||
Yes | 641 | 13.10 | |
No | 4253 | 86.90 | |
Effects of a stroke | |||
Yes | 63 | 1.30 | |
No | 4837 | 98.70 | |
Mobility trouble | |||
Yes | 149 | 3.10 | |
No | 4748 | 96.90 |
As can been seen in Table
Barriers by participation (weighted sample).
Variable | Category |
|
% |
---|---|---|---|
Participant | |||
Yes | 308 | 6.9 | |
Cost | No | 4130 | 93.1 |
Nonparticipant | |||
Yes | 26 | 5.7 | |
No | 433 | 94.3 | |
| |||
Participant | |||
Yes | 147 | 3.3 | |
Transportation | No | 4291 | 96.7 |
Nonparticipant | |||
Yes | 15 | 3.3 | |
No | 444 | 96.7 | |
| |||
Participant | |||
Yes | 283 | 6.4 | |
Not available in area | No | 4156 | 93.6 |
Nonparticipant | |||
Yes | 14 | 3.1 | |
No | 445 | 96.9 | |
| |||
Participant | |||
Yes | 50 | 1.1 | |
Not physically accessible | No | 4389 | 98.9 |
Nonparticipant | |||
Yes | 4 | 0.9 | |
No | 455 | 99.1 | |
| |||
Participant | |||
Yes | 173 | 3.9 | |
Location is too far | No | 4266 | 96.1 |
Nonparticipant | |||
Yes | 8 | 1.7 | |
No | 451 | 98.3 | |
| |||
Participant | |||
Yes | 76 | 1.7 | |
Fear of injury | No | 4363 | 98.3 |
Nonparticipant | |||
Yes | 5 | 1.1 | |
No | 454 | 98.9 | |
| |||
Participant | |||
Yes | 1922 | 43.3 | |
Lack of time | No | 2517 | 56.7 |
Nonparticipant | |||
Yes | 184 | 40.1 | |
No | 275 | 56.9 | |
| |||
Participant | |||
Yes | 456 | 10.3 | |
Lack of energy | No | 3982 | 89.7 |
Nonparticipant | |||
Yes | 72 | 15.7 | |
No | 387 | 84.3 | |
| |||
Participant | |||
Yes | 1281 | 28.9 | |
Lack of motivation | No | 3158 | 71.1 |
Nonparticipant | |||
Yes | 146 | 31.8 | |
No | 313 | 68.2 | |
| |||
Participant | |||
Yes | 34 | 0.8 | |
Lack of skills or knowledge | No | 4404 | 99.2 |
Nonparticipant | |||
Yes | 4 | 0.9 | |
No | 454 | 99.1 |
Odds of nonparticipation as a function of type of barrier.
Barrier | Males | Females | ||
---|---|---|---|---|
Odds ratios | 95% CI | Odds ratios | 95% CI | |
Cost | 2.05 | 0.73, 5.74 | 1.07 | 0.67, 1.71 |
Transportation | 0.89 | 0.16, 5.04 | 1.03 | 0.56, 1.88 |
Not available in area |
|
|
1.50 | 0.81, 2.78 |
Location not physically accessible | 0.33 | 0.05, 2.31 | 1.53 | 0.39, 5.94 |
Location is too far | 11.96 | 0.46, 313.09 | 1.70 | 0.76, 3.80 |
Fear of injury | 2.29 | 0.25, 21.50 | 1.59 | 0.58, 4.34 |
Lack of time | 0.79 | 0.56, 1.13 |
|
|
Lack of energy | 0.91 | 0.56, 1.48 |
|
|
Lack of motivation |
|
|
1.18 | 0.88, 1.58 |
Lack of skills/knowledge | 0.75 | 0.07, 8.09 | 0.78 | 0.25, 2.40 |
*
Given that barriers were not strong predictors of nonparticipation, we examined the influence of self-reported general health status. As seen in Table
Odds of nonparticipation as a function of self-rated general health status.
Barrier | Males | Females | ||
---|---|---|---|---|
Odds ratios | 95% CI | Odds ratios | 95% CI | |
Excellent/very good | 0.74 | 0.45, 1.20 | 0.74 | 0.45, 1.20 |
Good | 0.78 | 0.46, 1.30 | 0.79 | 0.46, 1.30 |
Fair/poor | 1.00 | Referent | 1.00 | Referent |
With regards to chronic health conditions, males and females identified a different number of predictors to nonparticipation (see Table
Odds of nonparticipation as a function of health condition.
Barrier | Males | Females | ||
---|---|---|---|---|
Odds ratio | 95% CI | Odds ratios | 95% CI | |
Vision function |
|
|
0.25 | 0.37, 1.67 |
Heart disease | 1.03 | 0.75, 1.41 |
|
|
COPD | 0.76 | 0.33, 1.77 |
|
|
Diabetes |
|
|
|
|
Osteoporosis | 0.42 | 0.11, 1.63 | 0.94 | 0.69, 1.28 |
Effects of a stroke | 1.07 | 0.36, 3.21 | 1.42 | 0.51, 3.98 |
Mobility trouble |
|
|
|
|
*
The purpose of this study was to examine the relationship between barriers to participation, self-reported health status, and chronic health conditions on nonparticipation in physical activity in Canadian seniors aged 60+ years who did not identify a health condition limitation, illness, or injury as a barrier to participation. Across both participants and nonparticipants, respondents on average identified 1.06 ± 0.72 barriers to participation in physical activity, with 89% of the respondents identifying no barriers to participation.
The barrier that had the highest likelihood of predicting nonparticipation differed between males and females. Males were more likely to be nonparticipants due to the activity not being available in their area, although this needs to be interpreted with some caution given the small sample size. In contrast, women were more likely to be nonparticipants due to time. Time being the most significant barrier to nonparticipation in women is supported by earlier work by Yoshida et al. [
Self-reported health status was not related to nonparticipation in the current sample. This may not be surprising given that this sample represented only those who did not identify a health condition, illness, or injury as barriers to participation. By limiting the sample to those who perceived their health as not posing a limiting factor, it is difficult to directly compare the results to other studies where health was consistently identified as the number one barrier to participation. What is surprising in the current study, however, is the relationship between chronic health conditions and nonparticipation. These results suggest that while Canadian seniors have underlying chronic health conditions they do not always identify them as being associated with their self-reported general health, nor do they view them as limiting conditions to participation in physical activity. This potential disconnect between self-reported health status and chronic health conditions is interesting, as heart disease, vision, COPD, diabetes, and mobility trouble increased the likelihood of nonparticipation across males and females. It is possible that these older adults have learned to compensate for these chronic health conditions in their everyday life and therefore no longer consider them barriers to participation nor consider them impacting their self-reported general health status. It is clear, however, that there are limiting factors to participation. Although health concerns have been considered motivators to participation [
These findings have implications for physical activity programming for seniors. While only a small number of older Canadians were identified who did not participate, this sample represented those who believed they did not have limitations to participation; effectively creating a “healthy” sample of older adults. Regardless of their self-perceptions, this group of seniors was less likely to participate because of underlying health conditions. This would suggest that programming should target the specific needs of older adults; whether that takes the form of activities and classes designed specifically for those with targeted health conditions, or increased knowledge of how to integrate and attract those with health conditions into preexisting classes. What is clear is that the results identify a dissociation between self-perceptions of health and the reasons older adults are at greater risk for nonparticipation.
This study is not without limitations. The derived variable we chose from the CCHS-HA dataset captures physical activity as any one of walking for pleasure or exercise, light sports, moderate sports, strenuous sports, and exercises to increase muscle strength and endurance. While this variable is all encompassing for physical activity, it does not include activities of daily living, which may also be considered by some to contribute to their daily physical activity levels. Second, the self-reporting of general health status does not take into account the fact that many older adults learn to accommodate health concerns and to compensate for their impact on daily activities. Thus, a physical performance based measurement of health status could quite possibly have produced a different pattern of findings. Third, the chronic health conditions selected were done so to represent an overall picture of health-related issues that may impact participation. Specifically, they were chosen to represent vision, respiratory function, cardiovascular health, neurological health, diabetes, and mobility. It is by no means an exhaustive list of all chronic health conditions; any of which could impact ones’ ability to participate in physical activity. The chronic health conditions were not validated in any way through performance measures, suggesting that their presence may have been under- or overrepresented in the self-reporting. Fourth, in predicting nonparticipation, the overall sample of nonparticipants represented only 9.4% of the total sample derived. Thus, the potential for type I error may be increased. Lastly, it was not possible to determine whether participants were meeting the recommended guidelines for participation in physical activity. While the PASE scores confirmed this group was more active than the nonparticipants, it was not possible to determine if this was due to frequency of participation or the duration of participation.
Overall this paper raises the issue that despite having created a “healthy” sample of older Canadians, there are still those who do not participate in regular physical activity. The 9.4% of seniors in this sample who did not participate is substantially smaller than the national average of 62%. However, it is important to note that this sample has been derived from older adults who reported no health condition or limitation preventing them from participating and thus is not representative of the general population of older adults. As such, their nonparticipation is not related to the presence of barriers such as opportunity or desire, but to specific chronic health conditions, and suggests a potential disconnect between self-perceived health and actual health status. Considering that only one-third or less of older Canadians achieve the recommended guidelines for leisure time physical activity [
This research was funded by the Social Sciences and Humanities Research Council of Canada, Grant no. 862-2010-0007 (P. L. Weir).