CARE OF THE OLDER PERSON

Physical activity among the elderly in China: a qualitative study Yanling Li, Xiaojing Du, Chunfang Zhang, Sibao Wang

Yanling Li is Master of Science in Nursing, Affiliated Hospital of Hebei University, China; Xiaojing Du is Senior Lecturer, Faculty of Nursing, Hebei University, China; Chunfang Zhang is the Vice President in Charge of Nursing, Affiliated Hospital of Hebei University, China; Sibao Wang is Research Director, Affiliated Hospital of Hebei University, China  Email: [email protected]

AbstracT

The benefits of physical activity are well known, but little is known about the views of elderly Chinese people regarding physical activity, and what factors affect this. This qualitative study aims to explore the experiences and perceptions of the elderly community regarding physical activity and to gain a better understanding of these. A qualitative study of 12 elderly Chinese people was undertaken using the Colaizzi phenomenological approach and using semi-structured interviews to gather data. Three key themes emerged relating to current physical activity status, beliefs about physical activity and factors influencing physical activity. This study provides new knowledge about the elderly community’s experiences and perceptions of physical activity. By understanding these, we may show that promoting active lifestyles and building physical activity into and around day-to-day activities are important strategies in increasing levels of activity. Furthermore, the need for appropriate activity facilities, available space, peer motivation and general social support could promote activity beliefs and subsequent adherence among the elderly community.

KEY WORDS Older people w physical activity w beliefs w qualitative approach

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people about physical activity. The purpose of this article is to explore the beliefs associated with maintenance of regular physical activity among elderly Chinese people. It informs our understanding of how programmes of activity could be designed and presented to motivate the elderly to initiate and adhere to these programmes and integrate physical activity into their daily lives.

Background The increase in life expectancy due to socioeconomic progress has led to a growth in the number of elderly people throughout the world (Tas et al, 2007), including China. In 2011, elderly people made up 13.26% of the population in China (National Bureau of Statistics of China, 2011). Ageing is one factor that is associated with chronic disease (Hurst et al, 2013), and physical and mental decline with age is inevitable. However, there is considerable evidence showing that older individuals that are physically active maintain healthy functioning lives longer than sedentary peers (Salguero et al, 2011). Physical activity has been identified as a priority area in general health promotion, as well as a specific objective for individuals’ health (US Department of Health and Human Services, 2010). Increasing levels of physical activity in the elderly is a key concern of UK health policy (Department of Health (DH), 2011). Physical activity is defined as ‘any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level’. This generally includes leisure, physical, household, and work-related activities (Physical Activity Guidelines Advisory Committee, 2008). The most recent UK guidelines advise that, per week, the elderly should undertake at least 150 minutes of moderate physical exercise (a little tiredness, sweating, body heat, breathing dyspnea when participating in activity) in bouts of 10 minutes or more, or 75 minutes of vigorous activity (tiredness, obviously sweating, body feeling very hot, shortness of breath when participating in activity), or a combination of these to achieve maximum benefits to health and wellbeing (National Institute

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he global population is ageing rapidly. It is estimated that 21% of the population will be aged 60 or more by 2050 (United Nations Department of Economics and Social Affairs, 2002). A major challenge related to the growing number of elderly people is the potential sharp increase in health-care needs due to age-related chronic diseases and disabilities (Barnett et al, 2012). Physical activity has been found to be crucial for preventing many chronic health problems, and for promoting mental health and wellbeing in the later years of life (Hamer and Stamatakis, 2010). While some work has been done showing that regular physical activity has many benefits for the elderly (Gillespie et al, 2009; Taylor et al, 2004; Paterson et al, 2007), relatively little previous research exists regarding the beliefs, experiences, and views of elderly Chinese

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CARE OF THE OLDER PERSON for Health and Care Excellence, 2008; Washburn et al, 1993). However, statistics continue to show that most elderly people don’t engage regularly and sufficiently in physical activity. Compared with 21.8% in the US, and 10% in the UK (Netz et al, 2011), a small number of elderly people reported performing sufficiently actively (Munter et al, 2005). Overall, sedentary behaviour among the elderly remains common, despite the evidence that a majority of the elderly report relatively positive attitudes towards physical activity (Harris et al, 2009).

Method Design

Given the exploratory nature of the enquiry and the limited existing evidence base, a qualitative approach using Colaizzi’s (1978) phenomenological theory was chosen, due to its commitment to lead discovery of the genuine experience of participants during deployment in this study. According to Husserl (1970), phenomenology attempts to describe the experience in terms of essential structures embedded in human phenomena. Phenomenology is the study of human experience from the viewpoint of those experiencing a specific phenomenon. Colaizzi’s (1978) method includes features of both descriptive and interpretive phenomenology. This study underwent a formal assessment by Hebei University’s research ethics committee.

Setting and sample A purposive sampling approach was used. Some 12 elderly people were recruited from six Chinese community settings and were from different backgrounds, to achieve the maximum possible variation of experiences and perceptions. All participants met the following inclusion criteria: Chinese; aged 60 years or older; living in the community; not having any cognitive problems and physical limitations in activities; able to communicate verbally; and willing to take part in the study. Participants’ demographic characteristics are described in Table 1.

recorded and transcribed verbatim. This method of data collection provides freedom for the participants to tell their stories. Data collection took place over 3 months and continued until saturation occurred without encountering any new themes. A list of interview questions can be found in Table 2. Recorded field notes were taken during the interviews, following the notation system of Schatzman and Strauss (1973). This approach included observational, theoretical, and methodological notes. Observational notes are statements bearing upon events experienced through watching and listening and provide the ‘who’, ‘where’, ‘when’, ‘what’, and ‘how’ of physical activity. Theoretical notes represent self-conscious, controlled efforts to extract meaning from observational notes. Methodological notes are statements that reflect upon an operational act that is planned or completed and may offer direction, such as an instruction, reminder, or a critique of the research methods.

Data analysis As stated, the taped interviews and field notes were transcribed verbatim. Data were analysed using procedures adapted from Colaizzi (1978): carefully read all the records; find disjunctive significant statements; encode a recurring point of view; bring the encoded view together; write a detailed and exhaustive description; identify a similar view; sublimate the theme concept; and return to the participants for the confirmation. Each step of the analysis was reviewed

Table 1. Age, gender, marital status and previous employment A

70, female

Married doctor

B

71, female

Divorced engineer

C

68, female

Widowed freelancer

D

65, male

Married worker

E

67, male

Married salesman

F

73, female

Divorced and remarried nurse

G

80, male

Widowed basketball player

H

73, female

Married architect

I

82, female

Widowed care assistant

J

71, male

Divorced and remarried, owned a business

K

69, female

Married teacher

L

63, male

Married administrative cadre

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Data collection Open-ended and semi-structured interviews were conducted in a place chosen by participants (mainly leisure centres and participants’ homes). Procedures relating to how data would be collected, used, stored and analysed were explained to the participants. Each interview lasted 30–90 minutes, with an average of 50 minutes of broad questions, such as: ‘what kinds of physical activity do you usually do?’; ‘what are the advantages and disadvantages associated with the physical activity?’; ‘what are the factors that affect your physical activity?’; ‘what are the benefits that keep you active?’. The above questions, specified by Ajzen and Fishbein (Ajzen and Madden, 1986), were used for the focus groups. Follow-up questions were asked to clarify statements, views, and meanings of content, and to gain a full range of attitudes and beliefs about initiating and maintaining physical activity. Interviews were audio

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CARE OF THE OLDER PERSON Table 2. Interview questions 1. What kinds of physical activity do you usually do? 2. What do you think are the advantages and disadvantages associated with physical activity for the elderly? 3. What are the factors of individual or groups that might affect your physical activity? 4. What are the benefits that keep you active?

‘There is a mountain near my hometown. When I was young, I often climbed it on weekends. Now retired, I usually travel and go hiking with my family during the holidays. It is becoming a part of my life.’ (Interview D, male, 65 years old) The elderly people mentioned many kinds of gentle and generally nonvigorous exercises, such as tai chi and eye exercises, which were most often used by the majority of elderly people in their daily life. Elderly people favour these activities, because they describe them as ‘fitness’, ‘softness’, ‘mildness’ and ‘slow in tempo’.

5. What helps you to stay active in everyday life?

and validated by the two expert consultants. Rigour was maintained through informed consent, confidentiality, audio-recording, and field notes in order to preserve the validity of the data. The sample size was determined by theoretical saturation, and saturation was driven by the emerging themes (Guest et al, 2006). In the 12 cases used in this study, the data shows saturation.

Results The following three themes emerged from the data analysis that was carried out: w Theme 1. Current physical activity status w Theme 2. Beliefs about physical activity w Theme 3. Influencing factors of physical activity. Respondents generally believed that their activity was firmly rooted in traditional Chinese culture and Chinese medical practice. However, from further investigation, it appeared that only a few of the elderly people were actually able to relate their ideas and practices about physical activity to traditional Chinese culture.

Theme 1. Current physical activity status Transportation activities Respondents reported that their way of travelling was mainly walking and cycling. The most frequent physical activity was walking. Respondents also referred to consciously choosing walking for shopping and to replace other means of transportation.

‘I like to walk to the senior centre every day to keep my spirits active. I walk to the shopping market as much as possible.’ (Interview A, female, 70 years old)

Leisure activities The amount of leisure-time activity undertaken by the elderly was lower than expected. However, some of the additional time available after withdrawal from previous employment was likely to be used for physical activity. Males were more active in leisure activity:

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Family activities Female respondents reported that they had not established a routine for exercises and sports, due to the fact that they were busy working to bring up the family, or because they had domestic and caring roles from an early age in line with cultural traditions. They also had a lack of knowledge about exercise and sports activities. Those who reported being active had managed to integrate physical activity within everyday life by taking grandchildren to and from school:

‘I sometimes do housework. I do not need to do those things, but I think doing these things is beneficial for my health.’ (Interview I, female, 82 years old) ‘Because my daughter and son-in-law are very busy, I have to prepare dinner and clean the house during the day to keep myself busy. I have no time to do other things.’ (Interview C, female, 68 years old)

Theme 2. Beliefs about physical activity Physical activity was considered key to preventing chronic disease, healing, and promoting health. Activities enhanced mood and spirit, stimulating the mind and body. The selfmanagement (individual perceptions rather than based on advice or recommendations) of regular physical activity, irrespective of type, was an important factor in maintaining a sense of physical, psychological and social wellbeing.

Physiological level Ageing was acknowledged to be an inevitable process, but respondents thought that the process could be slowed by maintaining good habits of physical activity. They stated that ‘the maximum benefit of physical activity is to maintain and promote physical healthiness’. Regular exercise and certain activities were thought to prevent many forms of degenerative diseases and to relieve certain symptoms such as joint stiffness, blood pressure or blood

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6. What prevents you from staying active in everyday life?

‘I participate in the activities of the tai chi sword form for about 30  minutes every Sunday morning, and then do eye exercises for 20 minutes.’ (Interview K, female, 69 years old)

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CARE OF THE OLDER PERSON

‘I do a medical rejuvenation operation every day; now my blood pressure is not high, the body is much better than before.’ (Interview A, female, 70 years old) ‘I would not feel well and could not sleep if I didn’t exercise. Every day I do activities and afterwards I feel very comfortable. ’ (Interview E, male, 67 years old) ‘Exercise is important for me, because it can keep me healthy. I feel the whole body blood flow more smoothly after exercise.’ (Interview G, male, 80 years old)

Psychological and spiritual level Respondents generally believed that when they felt stressed, physical activity could have stress-relieving benefits, create a clear mind, get rid of daily hassles, and allow one to feel much happier. They believed that physical activity could improve understanding of their own values, strengthen selfconfidence and increase social adaptability. Physical activity was believed to increase self-efficacy, promote physical competence ability and body acceptance, and enhance selfesteem:

‘When I do tai chi sword, my body dances with the music, and the attractive physical posture provides me with a feeling of happiness and satisfaction.’ (Interview F, female, 73 years old) ‘I regularly go hiking, and whenever I reach the top of the mountain, all unpleasant feelings are gone. I feel as though I am back to my younger times!’ (Interview D, male, 65 years old)

Social relationships The elderly believe that physical activity can improve relationships, enhance social participation, and increase opportunities for contact with people. Experience of talking to friends during activity can relieve solitude and loneliness.

‘I always exercise with my good friends. We also discuss how to take care of ourselves in order to enhance physical wellbeing... It makes us very happy and our moods very good.’ (Interview H, female, 73 years old) ‘I met some friends while doing my tai chi sword classes, and I talk to them about happy things or things that are more worrying.’ (Interview K, female, 69 years old)

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Disadvantages associated with physical activity Some elderly people emphasised the disadvantages of physical activity, with a few reporting some potential dangers of engaging in activities, possibly accompanied by pain and injury.

‘I think I cannot do intensive exercise.Years make me older and older, and I am weaker than before. Now going downstairs really hurts my knees seriously.’ (Interview B, female, 71 years old) ‘If you don’t do enough warm-up exercise before formal activities, your feet, your shoulder, or your hip get hurt easily. If you get hurt, you are in trouble.’ (Interview F, female, 73 years old) ‘My son and daughter-in-law both work until very late. I need to do a lot of housework and take care of my grandchildren.Too much housework can make me feel fatigued. Sometimes I suffer from muscle and bone pain.’ (Interview C, Female, 68 years old) The link between health and activity is clearly an integral part of life for many elderly people, and suitable activities were characterised as having a slow and harmonious rhythm, because respondents considered themselves to be a physically weak group. Of course, they stated that they could control the intensity and duration of physical activities: if they felt any pain or discomfort, they could stop their physical activity immediately.

‘If you choose suitable types of activities for yourself, you will not hurt your body.’ (Interview D, male, 65 years old)

Theme 3. Factors influencing physical activity The interview study identified individual, social, and environmental influences that allow sufficient physical activity to maintain physical condition and delay the ageing process.

Individual influences State of health Ageing is associated with increased risk of various chronic health conditions, including certain types of cardiovascular and musculoskeletal disease. Poor state of health is the most common factor preventing the elderly from physical activity.

‘I was a basketball player when I was younger, but growing older limits my physical ability. I should be careful to choose suitable activities.’ (Interview G, male, 80 years old) ‘I have problems with my joints and muscles, so exercising for any length of time involves

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sugar levels. However, this view was sometimes taken to an extreme, and some elderly people even believed that physical exercise could speed up the recovery process when experiencing health problems:

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‘I have lumbago and other chronic disease, so I prefer sitting and am unwilling to exercise.’ (Interview B, female, 71 years old)

Economic factors Some older people have no reliable source of income, limiting the types and scope of activities:

‘I have no pension to buy fitness equipment like other people. I cannot participate in fitness classes, so I have to go for a walk to keep my muscles active.’ (Interview C, female, 70 years old)

Internal motivators Among the elderly, weight control and experiencing health benefits were most often stated as ‘internal motivators’. Weight control was a motivation for older women, either to assist with losing weight or maintaining weight, aiming at getting into shape. Other benefits from physical activity were commonly considered as motivators, including being fit and feeling good about oneself, entertainment, and improving mental outlook:

‘Physical activity is important for maintaining health. No-one but myself can help me keep physically active.’ (Interview A, female, 70 years old) ‘Now I love playing table tennis, for one hour everyday, come rain or shine.’ (Interview E, male, 67 years old) ‘I remain in pretty good shape despite my age. This is because I eat less and am very active. Do not assume that the elderly do not love to be beautiful.’ (Interview A, female, 70 years old) Respondents mentioned having activity partners as motivators for physical activity. Lack of company was commonly cited as a reason that stopped them from being as active as they would like to be. Physical activity with others was described as being more motivating, more enjoyable, and as making people push themselves to exercise a bit harder or longer.

‘It is very strange to walk alone.’ (Interview E, male, 67 years old)

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Family influences Most elderly people mentioned that they receive encouragement or support for activity from members of their family, which usually came from their spouse and children.

‘My son told me that the most important thing is to take good care of myself. He bought a bike for me in order to encourage my daily exercise.’ (Interview K, female, 69 years old) ‘My son and daughter were busy with overtime work and various social activities, and had no time to do housework. So I do like to do cooking and see the children and other housework, and have no time to go out.’ (Interview C, female, 68 years old)

Social influences Respondents commented on how general social support and encouragement were key factors in motivating them to initiate physical activity. This support came from community, friends, and peers, but mainly community. Such organisations are a positive factor to promote and enrich the lives of the elderly.

‘The community health service centre provides health talks every week, and the nurses of the health centre provide consulting services on chronic disease.’ (Interview L, male, 63 years old) ‘My original work was in hospital. Now I am retired, but the veteran cadres branch of the hospital still regularly organises singing groups and chess-playing contests.’ (Interview A, female, 70 years old)

Physical environmental influences The physical environment might be especially relevant for elderly people with muscle and joint pain, among others, while the associated fear for them of moving outdoors might cause more troubles in overcoming physical barriers towards physical activity (e.g. greater distances, slopes, obstacles). ‘No available space’ and ‘terrible traffic’ are factors that made physical activity difficult, and people most commonly reported wanting more space and greater affordability of facilities for physical activity around their local neighbourhood.

‘I used to exercise with my husband. If he was not available, I just stayed at home and watched TV.’ (Interview H, female, 73 years old)

‘I would like to ride my bike outside. However, the traffic is terrible and I don’t feel comfortable enough to enjoy the bike riding. I really wish there was a safe environment for older people to exercise.’ (Interview K, female, 69 years old)

‘I joined the swimming team. Together with members of the group, I discovered the power of exercise.’ (Interview L, male, 63 years old)

‘The residential environment is not satisfactory and there is no exercise space and equipment.’ (Interview A, female, 70 years old)

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episodes of pain, not to mention other activities.’ (Interview F, female, 73 years old)

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Discussions There are very few studies on this topic in the international literature and none in China. Previous qualitative studies have found that the prevailing belief of white, black, and minority ethnic older adults is that physical activity has benefits for physical and psychological health (Paterson et al, 2007; Song, 2008). The present study was the first to verify the beliefs about physical activity among elderly Chinese people.

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Definitions The ‘elderly community’ means healthy (physically able, in a stable state) elderly people aged 60 and over living in the community for more than 6  months (Salguero et al, 2011). ‘Physical activity’ refers to a variety of activity types, including occupational, transportation, domestic, and leisure activities resulting in any body movement of skeletal muscles contracting to significantly increase energy expenditure (Tribe et al, 2012). The human ageing process leads to a decrease in physical activity practices, and studies have shown that older women exhibit a greater decline than men (Najdi et al, 2011). Women have been discouraged from participating in leisure time because of a cultural emphasis on women’s roles as housewives and caregivers. The housework domain seems to have an important role in the distribution of time devoted to the practice of physical activity by women (Najdi et al, 2011). Elderly males seem to have more leisure time for physical activity than elderly females. Increasing the level of physical activity is important for the health of elderly individuals, regardless of the social domain that they inhabit (Tribess et al, 2009). The people interviewed preferred to walk, because walking is safe, economical, convenient, and has fitness effects, known as ‘the most perfect forms of physical activity’. Older women tend to use traditional fitness methods, such as tai chi, tai chi sword, medical rejuvenation gymnastics, and so on. Older men tend to play table tennis and hill climb. More emphasis was given to leisure activities, due to the fact that the benefits seem to be greater in the leisure domain. This is commonly highlighted in the literature (Lee et al, 2011). Fewer of the elderly people interviewed use leisure activities, perhaps due to economic, time, or health conditions not permitting. Overall, the form of physical activity is relatively poor, and the amount of physical activity of individuals is relatively small. Overall, the level of activity among the elderly Chinese community is low, especially during leisure time. This is consistent with the results of other studies (Hughes et al, 2008). Physical activity enables the elderly to have an opportunity for a more active and independent life, contributing to the maintenance of functional autonomy and better quality of life (Allison et al, 2012). Participants identified advantages associated with physical activity in multiple domains, including physical, psychosocial, and spiritual health. These results are similar to other studies (Liu et al, 2012). The elderly people interviewed thought that maintaining and promoting physical health was the

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greatest benefit, followed by social and entertainment benefits, including, among others, improving relationships, enhancing overall community participation, relaxing, improving one’s mood, getting rid of daily hassles and providing psychological transfer, relieving fatigue, and maintaining overall health status. Some elderly people who perceived some disadvantages of physical activity may have suffered negative consequences brought about by physical activity, while others did not mention any disadvantages, as they believed that they could control the intensity and duration of activity and that when they felt any discomfort or pain, they could stop their activity immediately. Elderly people engaged in domestic activities generally reported lower back pain. The younger generation may be tired after working and require clothing to hand and food to mouth after returning home, so they may be hopeful that sharing of housework will be possible. The interview study identified individual, social, and environmental influences that could allow regular physical activity to help maintain good physical condition and delay the ageing process. One study, which was designed to examine factors influencing the exercise behaviour of older adults, showed that factors such as health, efficacy, motivation, and social support influenced desire and ability to exercise (Stiggelbout et al, 2012). The interviews indicated that the majority of older women spent a lot of time in housekeeping, care-giving, and workday activities. Other personal barriers included health concerns and lack of motivation. It is particularly noteworthy that the health benefits seemed to take a subordinate position to psychosocial and social factors in long-term maintenance of physical activity (Horne et al, 2012). Physical activity among the elderly people interviewed was often motivated by a desire to avoid bodily weakness and to increase strength. Other motivating factors included feeling good about oneself, entertainment, and improving mental outlook. Although parallels can be found in the literature (Horne et al, 2012; Jepson et al, 2012), this is the first time that this has been shown among the elderly Chinese community.

Summary of results In this study, the most common environmental barriers to becoming more active included safety, availability, and cost. In fact, since the 1990s, American, European, and Australian studies have shown that the physical environment is closely associated with leisure-time physical activity in the elderly (Salvador et al, 2009). The physical environment is defined as ‘the objective and perceived characteristics of the physical context in which people spend their time (e.g. home, neighbourhood), including aspects of urban design (e.g. presence of sidewalks), traffic density and speed, distance to and design of venues for physical activity (e.g. parks)’ (Van Cauwenberg et al, 2011). Different physical environmental characteristics are related to specific physical activity domains: transportation, recreation, household, and occupation (Van Cauwenberg et al, 2011). In this study, participants reported the individuals or groups of people influencing physical activity were spouses,

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Implications of practice for community nurses The findings suggest practical implications for community nurses with regard to assisting in the building of physical activity beliefs and increasing activity levels in the elderly. Structural interventions are relevant, such as educational programmes that will motivate the elderly community to initiate and adhere to physical activities, and to keep physically and psychologically healthy.

Limitations and future research One limitation is that it is difficult in qualitative studies of this kind to be certain of the broader generalisability of the findings. However, we believe that the depth of enquiry has generated insights that are likely to be broadly transferable to elderly Chinese people living in other parts of the world, such as the UK. Further research is required to investigate the experiences of those from different ethnic and cultural backgrounds, and from other practical

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settings such as an urban clinic or a rural health centre. It could be used to gain more information about physical activity. In addition, social support could be an important factor in influencing leisure physical activity and this needs further detailed exploration.

Conclusion This study has sought a new knowledge of the elderly community’s experiences and perceptions of physical activity, and aimed to gain a better understanding of these. It is recognised that promoting active lifestyles and building physical activity in and around day-to-day activities are important strategies in increasing activity levels. However, the need for appropriate activity facilities, available space, peer motivation, and general social support could promote activity beliefs and subsequent adherence among the elderly community.  BJCN Acknowledgements: The authors would like to thank the participants who volunteered their time to take part in this study. Ethical approval: Hebei University’s Research Ethics Committee. Conflict of interest: None declared.  Ajzen I, Madden TJ (1986) Prediction of goal-directed behavior: attitudes, intentions, and perceived behavioral control. J Exp Soc Psycho 22(4): 453–74 Allison J, Soham A, Amol K et al (2012) Routine physical activity and mortality in Mexican Americans aged 75 and older. J Am Geriatr Soc 60(6): 1085–91 Barnett I, MF Esther, van Sluijs et al (2012) Physical activity and transitioning to retirement. Am J Prev Med 43(3): 329–36 Cohen-Mansfield J, Marx MS, Guralnik JM (2003) Motivators and barriers to exercise in an older community-dwelling population. J Aging Phys Activ 11(2): 242–53 Colaizzi P (1978) Psychological research as the phenomenologist re-views it. In:Valle R, King M, eds. Existential-Phenomenological Alternatives in Psychology. Oxford Press, NY: 48–71 Department of Health (DH) (2011) Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries. http://tinyurl.com/q39gtzr (accessed 25 June 2013) Gillespie LD, Gillespie WJ, Robertson MC et al (2009) Interventions for Preventing Falls in Elderly People [Cochrane review]. Cochrane Library, Oxford Guest G, Bunce A, Johnson L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1): 59–82 Hamer M, Stamatakis E (2010) Objectively assessed physical activity, fitness and subjective wellbeing. Ment Health Phys Act 3(1): 67–71 Harris TJ, Owen CG, Victor CR et al (2009) What factors are associated with physical activity in older people, assessed objectively by accelerometry? Br J Sports Med 43(4): 442–50 Horne M, Skelton DA, Speed S et al (2012) Attitudes and beliefs to the uptake and maintenance of physical activity among community-dwelling South Asians aged 60-70 years: a qualitative study. Public Health 126(4): 417–23 Hughes JP, McDowell MA, Brody DJ (2008) Leisure-time physical activity among US adults 60 or more years of age: results from NHANES 19992004. J Phys Act Health 5(3): 347–58 Hurst G, Wilson P, Dickinson A (2013) Older people: how do they find out about their health? A pilot study. Br J Comm Nurs 18(1): 34–9 Husserl E (1970) The Crisis of European Science and Transcendental Phenomenology: An Introduction to Phenomenological Philosophy (Carr, D, trans.) Northwestern University Press, Evanston IL Jepson R, Harris FM, Bowes A et al (2012) Physical activity in South Asians: An in-depth qualitative study to explore motivations and facilitators. PLoS One 7(10): e45333 Lee DC, Sui X, Ortega FB et al (2011) Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med 45(5): 504–10 Liu Z, Speed S, Beaver K (2012) Perceptions and attitudes towards exercise among Chinese elders—the implications of culturally based self-management strategies for effective health-related help-seeking and person-centred care. Health Expect 1: 1–12

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children, friends, physicians, and nurses. Most respondents believed that family members encouraged them to exercise, and then they received considerable information about the benefits of physical activity provided by the community. The additional benefit of such an education was the establishing of a social norm to improve physical activity patterns among seniors who belonged to a different environmental background. Therefore, providing correct information about the benefits of physical activity and the creation of a positive environmental context could be an effective intervention for older adults to increase their activity level. In the UK, tailored exercise offered by professionals is recommended (DH, 2011; Mitchell, 2011), that is, exercise programmes based on professionals’ judgements of the specific situation of each individual based on medical conditions and personal circumstances. Available, affordable, and safe physical activity programmes are important issues (Mitchell, 2011). The elderly have to overcome more environmental barriers, and their perceived negative beliefs about activity, so linking with other health-related resources to set up physical activity programmes would therefore be a way to increase the motivation of elderly people. Another study showed that subjects with high levels of social support for physical activity were significantly less likely to be sedentary than those with low support (Cohen-Mansfield et al, 2003). On the basis of the study results, enhancing social support may be an important factor of interventions aimed at increasing physical activity in populations. Retirement is accompanied by the decline of physiological and cognitive functions, and social roles and social networks also change accordingly. They need more social support and social participation to adapt (Park and Lee, 2007). Although social support is frequently considered to be correlated with physical activity, this relationship has been evident largely in cross-sectional studies, with few prospective studies supporting this result (Satariano and McAuley, 2003).

British Journal of Community Nursing Vol 18, No 7

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CARE OF THE OLDER PERSON Mitchell M (2011) Falls prevention among the elderly: an update from Age UK. Br J Comm Nurs 16(6): 300–1 Munter P, Gu D, Wildman RP et al (2005) Prevalence of physical activity among Chinese adults: results from the international collaborative study of cardiovascular disease in Asia. Am J Public Health 95: 1632–6 National Bureau of Statistics of China (2011) Press release on major figures of the 2010 national population census. www.stats.gov.cn/English/newsandcomingevents/t20110428_402722237.htm (accessed 25 June 2013) Najdi A, Achhab Y, Nejjari C (2011) Correlates of physical activity in Morocco. Prev Med 52(3): 355–7 Netz Y, Goldsmith R, Shimony T (2011) Recommendations in older adults: an Israeli national survey. J Aging Phys Activ 19(1): 30–47 National Institute for Health and Care Excellence (2008) Occupational Therapy Interventions and Physical Activity Interventions to Promote the Mental Wellbeing of Older People in Primary Care and Residential Care. www.nice.org.uk/nicemedia/pdf/PH16Guidance.pdf (accessed 25 June 2013) Park K, Lee Y (2007) Association of social support and social activity with physical functioning in older persons. Prev Med Public Health 40(2): 137–44 Paterson DH, Jones GR, Rice CL et al (2007) Ageing and physical activity: evidence to develop exercise recommendations for older adults. Appl Physiol Nutr Metab 32: S69–108

LEARNING POINTS w There are many factors influencing physical activity among

the elderly w Understanding why elders don’t engage sufficiently in physical activity and what shapes their physical activity beliefs is crucial, as this can impact on the physical, psychological, and social wellbeing of the elderly w Community nurses have a major role to play in assisting to build physical activity beliefs and increase activity levels of the elderly

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British Journal of Community Nursing Vol 18, No 7

Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 16, 2015. For personal use only. No other uses without permission. . All rights re

Physical activity among the elderly in China: a qualitative study.

The benefits of physical activity are well known, but little is known about the views of elderly Chinese people regarding physical activity, and what ...
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