Doctor of Philosophy
School of Medicine
Noradechanunt, Chaiya, Promotion of low intensity physical activity in inactive older adults, Doctor of Philosophy thesis, School of Medicine, University of Wollongong, 2013. http://ro.uow.edu.au/theses/4149
Regular physical activity is well acknowledged as having considerable potential to promote the health and well-being of older persons. However, in most developed countries, such as Australia, a significant proportion of the older population does not meet currently recommended levels of physical activity; indeed the rates of inactivity tend to increase with advancing age. Adoption of a physically inactive lifestyle is associated with significant secondary economic consequences placing considerable burden on the health care system. Therefore, increases in the levels of physical activity in the older adult population have been identified as a public health priority.
Despite recognition of the importance of physical activity, very little information is available on the predictors of the various dimensions of physical activity among older adults, particularly for the different domains of physical activity mentioned in physical activity recommendations (e.g. vigorous- and moderate-intensity, walking, resistance, balance and flexibility activities), as well as the various types of recreational non-physical activity. It is unclear which factors are most important to older adults’ participation in each of these specific domains of physical activity. Furthermore, empirical evidence on the comparative efficacy of low-intensity exercise regimens that promote increased level of physical activity, and improved physical function and quality of life among physically inactive older adults is limited.
The first purpose of this research program was to examine the potential predictive factors associated with non-physical activity recreation and physical activity among a populationbased sample of adults aged over 50. The second, to investigate the effects of structured low-intensity balance and range of motion exercise regimens on older people’s levels of physical activity, functional fitness and quality of life. In Study 1 a cross-sectional mail descriptive survey was administered to a random population drawn from the NSW Electoral Roll (N=310). The aim was to describe the prevalence and patterns of recreational and physical activity and to explore potential predictors of participation in non-physical activity recreation and physical activity. Study 2 utilised a randomised controlled trial to determine the effects of two forms of low-intensity balance-flexibility exercise regimen (Tai Chi and Thai Yoga) on physical activity and functional health among physically inactive older adults (N=39).
Study 1 showed that more than three-quarters of respondents attained the recommended levels of overall physical activity. However, less than half of them achieved sufficient levels of vigorous activity, moderate activity, or even walking which was the most common physical activity performed in the previous week. Indeed, less than one-quarter of the respondents met the physical activity guidelines for taking part in muscle strengthening and flexibility activities, and approximately half of those reported no participation in these activities during the week before the survey. This was reflected in the high levels of sedentary behaviour among the sample; nearly two-thirds of the respondents reported sitting for longer than three hours a day. Further, light activities and household chores were found to be the most common recreation activities among middle-age and older adults. The most preferred activities that respondents intended to do in the near future were gentle physical activities, including participation in the interventions proposed in Study 2.
The principal predictors of participation in recreational non-physical activities were the availability of recreational facilities, attitudes to physical activity and long-term health conditions. Attitudes to physical activity, the perceived benefits of, and barriers to physical activity, and long-term health conditions were significantly associated with participation in physical activity.
These results imply that interventions to promote physical activity need to address different factors for different domains of physical activity. They suggest that health promotion programs should target the enhancement of middle-age and older people’s positive attitudes and motivation, provide education about the health and social benefits of physical activity, and attempt to eliminate or modify perceived barriers to the achievement of desired behavioural changes. They also highlight the need for public policy to provide available, accessible and convenient physical activity facilities and promote awareness of available local recreation facilities. The findings from Study 1 guided the direction of the subsequent intervention study (Study 2) in response to the expressed demand for less strenuous exercise programs and the low rates of muscle strengthening and flexibility activity participation found among older people.
Study 2 demonstrated that Thai Yoga participants significantly improved upper-body strength (28.8%), lower-body strength (28.4%), upper-body flexibility (64.1%), lowerbody flexibility (103.8%), agility and dynamic balance (14.6%), aerobic endurance (11.3%), SF-36 vitality dimension (17.7%), and their scores on the Physical Activity Enjoyment Scale (24.0%). These beneficial effects were maintained 12 weeks after completion of the intervention. In contrast, similar improvements were not observed after the 12-week Tai Chi intervention. These findings provide the first objective evidence that low-intensity flexibility-balance exercise has significant beneficial effects on physical and psychological functioning in physically inactive older adults, and that these benefits are comparable to those of ‘traditional’ multicomponent exercise programs. The findings suggest that older people can improve their health and well-being through low-intensity exercise regimens, and that Thai Yoga can be incorporated as an effective strategy to promote physical activity participation and improvements in the functional fitness and quality of life of older adults.
In conclusion, this research program significantly contributes to the evidence base by providing new empirical information that fills a gap in the literature. Such information can be used to enhance not only the understanding of individual-level variables contributing to leisure-time physical activity in the middle-age and elderly population, but also the knowledge about the health benefits that follow from low-intensity balance and flexibility exercise regimens. The inclusion of multilevel factors of psychological, social and environmental variables to predict the different domains of leisure-time physical activity in middle aged and older adults (Study 1) sheds some light on which variables future investigators should focus on to develop specific programs promoting active lifestyles in this population. The new empirical knowledge gained from the intervention study (Study 2) will assist older people to adopt leisure-time physical activity, make it a sustainable part of their lives, and help improve their health and well-being.