Strategies to promote physical activity for healthy ageing

Abstract

This thesis aimed to investigate strategies for improving physical activity participation among older adults. Strategies explored included health coaching, pedometers, structured exercise and goal setting. A meta-analysis of randomized controlled trials (RCTs) incorporating health coaching for improving physical activity among older people found a significant and small effect of health coaching on physical activity (27 studies; standardised mean difference (SMD = 0.27; 95% CI 0.18 to 0.37). To summarise the impact of pedometer-based interventions on physical activity among older adults, another metaanalysis was undertaken. The pooled estimated effect of pedometer-based intervention revealed a moderate, statistically significant impact on physical activity (23 studies; SMD = 0.55; 95% CI 0.40 to 0.70) and increased steps/day by 1558. In order to understand the motivators and barriers associated with ongoing exercise participation among older adults, a survey was conducted among a unique group of long-term regular members of a local government group exercise program (Strong Seniors). Personal benefits of exercise and social influences were the most common motivators for regular exercise. Barriers to participation included health problems and lack of time. Furthermore, an RCT was conducted to evaluate the impact of a combined physical activity and falls prevention among older people. The intervention was associated with significantly higher mobility goal attainment at six months (OR 1.97, 95% CI 1.06 to 3.68). Although there was a trend towards an effect on physical activity outcomes, physical activity counts were not significantly different between groups at six months (mean difference=12.8 CPM, 95%CI -98.3 to 123.9) or 12 months (55.6 CPM, 95%CI -13.8 to 125.0). To investigate goals set by older people and associations between the setting of balance-related goals and gender, fall history, self-rated balance, and fear of falling. Goals related to recreation and leisure and walking were the most common function-related goals selected. Men and women set similar goals. Participants who had poor/fair self-reported balance were more likely to set a balance-related goal than people with good self- rated balance. In contrast, fallers and participants who had a fear of falling were not more likely to select a balance-related goal than non-fallers and participants who had no fear of falling, respectively.