Enablers and barriers to older people’s participation in strength and balance activities: A review of reviews

Abstract

Encouraging physical activity is a key aspect of public health, with links to significant health benefits, including reducing the risk of a range of diseases, e.g. coronary heart disease, stroke, type 2 diabetes, and helping to maintain a healthy weight 1,2. The UK Chief Medical Officers' (CMOs) guidelines for physical activity present evidence-based, age-specific recommendation for physical activity to improve public health 3. Alongside recommendations for aerobic physical activity (150 minutes per week of at least moderate intensity physical activity, or 75 minutes per week of vigorous intensity physical activity) are specific recommendations for enhancing strength and balance (Table 1): Mainstream planning and delivery on physical activity typically focusses on the general physical activity guideline, with the strength and balance aspect largely considered for specific populations and outcomes, such as programmes aimed at older adults, or programmes aiming to prevent falls. It is unclear whether this lack of focus on the strength and balance aspect of the recommendations is driven by a professional bias (e.g. if the public health community was uncertain of the importance of the recommendations or unsure how to implement them) or barriers to implementation faced by older adults themselves 4. This review therefore Abstract Objectives: This review sought to investigate the question: what are the key barriers to, and enablers for, older adults undertaking muscle strengthening and balance activities, and how can these be addressed by individuals and practitioners? Methods: A search of PubMed for review-level evidence on professional and personal barriers and motivators for strength and balance activities among older people. Results: The search and expert consultation found 46 studies; after screening, twelve papers were included. Many of the barriers and motivators to strength and balance activities are familiar ones that can also apply to physical activity more generally, such as not having the time. More specific barriers to strength and balance activities for older people were perceived risk of a heart attack, stroke, or death, and fear of looking too muscular; with motivators being improved ability to complete daily activities, preventing deterioration and disability, and decreasing the risk or fear of falling. Conclusions: This review of reviews has found a small but consistent body of literature describing the motivators and barriers to older adults taking part in strength and balance activities. This may be used as the basis for planning and delivering physical activity programmes for older adults.

Motives for physical activity in older men and women: A twin study using accelerometer‐measured physical activity

“…Social aspects related to physical activity were also more important for moderately to vigorously physically active older women than for inactive older women, but in older men, there was no difference in this motivational factor. Comparisons of our findings with those of previous systematic reviews evaluating older individuals' motives for physical activity 9,10 reveal that physical and psychological health and well-being, as well as enjoyment, seem to be major and universal motivational factors to be physically active in older individuals. Previous studies have also indicated the social aspects of physical activity as important motivational factors, but we could not confirm this result in the present study.…”

“…Furthermore, we examine to what extent genetic and environmental factors contribute to motives for physical activity. Based on previous studies, 9,10 we hypothesize that both physical health and psychological health along with enjoyment of physical activity are the most important factors to induce both older men and women to be physically active. Further, based on previous findings, 6,11 we hypothesize that there are sex differences in motives for physical activity among older individuals-older women are assumed to be more likely motivated by their appearance and the social aspect of physical activity than older men.…”

“…7,8 Two systematic reviews have evaluated motives for physical activity in old individuals, but they did not include meta-analyses to estimate pooled effect sizes. 9,10 Baert at al. (2011) 9 reported physical health as a major intrapersonal motive for physical activity in several studies in individuals in their 80s, followed by psychological benefits, such as enjoyment.…”

“…The effect of professional advice was also mentioned in a few papers included in the review. In a review of reviews, Cavill & Foster (2018) 10 focused on motives to participate in strength and balance training activities in middle-aged and older individuals. Some of the motives found in this review were very general to all people for being physically active, such as psychological health benefits and social connection with others, while some motives were more specific to older individuals, such as improving the ability to complete daily activities and reducing the risk/fear of falling.…”

The Footfall Programme: participant experiences of a lower limb, foot and ankle exercise intervention for falls prevention - an exploratory study

“…Adherence to home-based interventions for falls prevention can be low and may be influenced by programme characteristics and the amount of support provided 7 . The social interaction that comes from group exercise interventions is highly valued by older adults 8 and facilitates acceptability 9 . It is possible that blended programmes, which combine intermittent group sessions (i.e.…”