Downloaded from http://jech.bmj.com/ on December 6, 2017 - Published by group.bmj.com
Commentary
Retirement and physical activity A A Laverty,1 E Flint2 A recent analysis of the EPIC-Norfolk cohort by Barnett et al found that retirement was associated with a decline in overall levels of physical activity as decreases in occupational and transport-related activity were not compensated for by increases in household and recreational activity.1 This study adds more accurate assessment of physical activity with a larger sample size than previous studies2 and allows the breakdown of physical activity across different domains, as well as investigation of socioeconomic differences. Although the main finding has been echoed in some previous studies,3 4 a 2012 systematic review by the same authors concluded that the impacts of retirement on overall physical activity were unclear.5 This lack of clarity was due to the paucity of accurate activity assessment in included studies, a gap that this study addresses and strengthens our confidence that retirement is indeed a time of declining physical activity. The study raises the possibility that intervening around the time of retirement may be one strategy to deal with low levels of physical activity, which is noted a serious concern worldwide.6 Barnett et al also found greater declines in physical activity for those previously in manual jobs compared with those in nonmanual jobs.1 This is a worrying yet familiar trend, with those at increased risk of conditions related to physical inactivity experiencing greater decreases in activity levels after retiring. The findings are not conclusive however. For example, manual versus non-manual men saw a similar magnitude of percentage decrease (28.5% vs 28.1% respectively, adapted from Tables 2 and 3 of Barnett et al). The categorisation into manual and non-manual work used by Barnett et al was presumably selected as numbers would have been too low to allow a more granular definition. The approach is justified, but has the unfortunate by-product of proxying occupational physical activity meaning that these groups were more physically active before retirement.
1
Primary Care and Public Health, Imperial College London, London, UK; 2Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK Correspondence to AA Laverty, Primary Care and Public Health, Imperial College London, London W6 8RP, UK; [email protected]
Nevertheless, perhaps the main gap in our knowledge is how to increase levels of physical activity in older adults. Barnett et al cite a study using the English Longitudinal Study of Ageing, which found that persons about to retire may be particularly receptive to behaviour change.7 This study examined rates of smoking cessation among those aged over 50 years and found that those who retired were more likely to quit than those who stayed in employment (42.5% vs 29.3%). The applicability of these findings to other behaviours such as physical activity is not known, but more work in this area would be beneficial. Retirement is widely acknowledged as a time of great potential for change, for example, moving house is common in the 12 months after retirement.8 What we do not know is whether people are likely to move to areas more or less conducive to physical activity. We do know, however, that what are traditionally thought of as non-health interventions can have an impact. The concessionary bus pass for those over the age of 60, for example, has been found to be associated with increases in walking and a lower body mass index among those with a bus pass.9 10 The bus pass has been provided in England since 2006 and allows those over 60 years old to use local buses free of charge outside of rush hour and was primarily aimed at preventing social exclusion.11 Again, the impact of the bus pass on overall levels of activity and on longerterm health outcomes is not known, but these findings provide evidence that the decline in physical activity is not an immutable phenomenon. There is a limited amount of research on encouraging physical activity in older adults. While there is indication that behavioural interventions may be effective in changing activity levels, it is not clear whether effects persist beyond 12 months.12 There is also no definitive evidence on whether certain modes of delivering interventions are more effective, which is likely to hamper efforts to increase activity levels.12 A meta-analysis concluded that levels of activity could be increased, but that challenges remain in developing interventions that are effective in generating more than modest changes.13 The study by Barnett et al also adds to our knowledge by providing the breakdown of physical activity across separate domains.
Laverty AA, et al. J Epidemiol Community Health August 2014 Vol 68 No 8
It is apparent that when working, occupation makes up a substantial proportion of physical activity. This highlights the substantial ground to be made up and presents the possibility that certain domains of activity may be easier to encourage among this age group, although again this is not fully understood. Barnett et al have classified retirement using a combination of self-reported items: whether respondents reported any paid work in the previous work and whether they reported any occupational physical activity. This thorough approach means we can be confident in the ‘retired group’ being ‘completely retired’. The authors also correctly acknowledge the increasingly complex conceptualisations of retirement, which is by no means a binary phenomenon.14 For example, effects of retirement have been shown to vary according to whether people retire voluntarily or in response to ill health.15 16 It is also possible that many people of this age may transition from full-time to part-time work as a prelude to full retirement, and we may need to know more about whether there are differential effects here. Analyses of the British Household Panel Survey have found that while health shocks can predict early retirement, having a partner who remains employed reduces the chances of retiring.17 Extrapolating this to physical activity, perhaps we should consider whether the employment status and activity levels of older adults are sometimes better considered in a couple, and perhaps this is the appropriate unit for any interventions to increase levels of physical activity. In conclusion, the recent study by Barnett et al is important and adds to our knowledge of changes in physical activity across the lifecourse. Despite caveats and remaining uncertainty, there is now enough evidence to support targeting those about to retire with health-enhancing interventions, including efforts to increase physical activity. Future research should investigate whether certain subgroups may be particularly amenable to change; whether particular domains of activity are more readily modified; and how this could be best achieved. Contributors AAL and EF planned, wrote and edited the paper equally. Both authors approved the final version for submission. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
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Downloaded from http://jech.bmj.com/ on December 6, 2017 - Published by group.bmj.com
Commentary To cite Laverty AA, Flint E. J Epidemiol Community Health 2014;68:701–702. Received 12 March 2014 Accepted 3 April 2014 Published Online First 29 April 2014
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▸ http://dx.doi.org/10.1136/jech-2013-203225
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J Epidemiol Community Health 2014;68:701–702. doi:10.1136/jech-2014-204149
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REFERENCES 1
2
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Barnett I, van Sluijs E, Ogilvie D, et al. Changes in household, transport and recreational physical activity and television viewing time across the transition to retirement: longitudinal evidence from the EPIC-Norfolk cohort. J Epidemiol Community Health 2014;68:747–53. Godfrey A, Lord S, Galna B, et al. The association between retirement and age on physical activity in older adults. Age Ageing 2013; doi:10.1093/ageing/ aft168 [ published Online First: Epub Date].
9
10
Berger U, Der G, Mutrie N, et al. The impact of retirement on physical activity. Ageing Soc 2005;25:181–95. Slingerland AS, van Lenthe FJ, Jukema JW, et al. Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study. Am J Epidemiol 2007;165:1356–63. Barnett I, van Sluijs EMF, Ogilvie D. Physical activity and transitioning to retirement: a systematic review. Am J Prev Med 2012;43:329–36. Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012;80:247–57. Lang IA, Rice NE, Wallace RB, et al. Smoking cessation and transition into retirement: analyses from the English Longitudinal Study of Ageing. Age Ageing 2007;36:638–43. Evandrou M, Falkingham J, Green M. Migration in later life: evidence from the British Household Panel Study. Office for National Statistics. Population Trends, 2010. Webb E, Netuveli G, Millett C. Free bus passes, use of public transport and obesity among older people in England. J Epidemiol Community Health 2012;66:176–80. Coronini-Cronberg S, Millett C, Laverty AA, et al. The impact of a free older persons’ bus pass on active travel and regular walking in England. Am J Public Health 2012;102:2141–8.
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Department for Transport. Improving local transport, concessionary bus travel. Secondary Department for Transport. Improving local transport, concessionary bus travel. https://www.gov.uk/government/policies/ improving-local-transport/supporting-pages/ increasing-the-use-of-buses Hobbs N, Godfrey A, Lara J, et al. Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med 2013;11:75. Conn V, Valentine J, Cooper H. Interventions to increase physical activity among aging adults: a meta-analysis. Ann Behav Med 2002;24:190–200. Denton FT, Spencer BG. What Is Retirement? A Review and Assessment of Alternative Concepts and Measures. Can J Aging 2009;28:63–76. Jokela M, Ferrie JE, Gimeno D, et al. From midlife to early old age: health trajectories associated with retirement. Epidemiology 2010;21:284–90. Stenholm S, Westerlund H, Salo P, et al. Age-related trajectories of physical functioning in work and retirement: the role of sociodemographic factors, lifestyle and disease. J Epidemiol Community Health 2014;68:747–53. Jones AM, Rice N, Roberts J. Sick of work or too sick to work? Evidence on self-reported health shocks and early retirement from the BHPS. Econ Model 2010;27:866–80.
Laverty AA, et al. J Epidemiol Community Health August 2014 Vol 68 No 8
Downloaded from http://jech.bmj.com/ on December 6, 2017 - Published by group.bmj.com
Retirement and physical activity A A Laverty and E Flint J Epidemiol Community Health 2014 68: 701-702 originally published online April 29, 2014
doi: 10.1136/jech-2014-204149 Updated information and services can be found at: http://jech.bmj.com/content/68/8/701
These include:
References Email alerting service
This article cites 13 articles, 3 of which you can access for free at: http://jech.bmj.com/content/68/8/701#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Commentary
Retirement and physical activity A A Laverty,1 E Flint2 A recent analysis of the EPIC-Norfolk cohort by Barnett et al found that retirement was associated with a decline in overall levels of physical activity as decreases in occupational and transport-related activity were not compensated for by increases in household and recreational activity.1 This study adds more accurate assessment of physical activity with a larger sample size than previous studies2 and allows the breakdown of physical activity across different domains, as well as investigation of socioeconomic differences. Although the main finding has been echoed in some previous studies,3 4 a 2012 systematic review by the same authors concluded that the impacts of retirement on overall physical activity were unclear.5 This lack of clarity was due to the paucity of accurate activity assessment in included studies, a gap that this study addresses and strengthens our confidence that retirement is indeed a time of declining physical activity. The study raises the possibility that intervening around the time of retirement may be one strategy to deal with low levels of physical activity, which is noted a serious concern worldwide.6 Barnett et al also found greater declines in physical activity for those previously in manual jobs compared with those in nonmanual jobs.1 This is a worrying yet familiar trend, with those at increased risk of conditions related to physical inactivity experiencing greater decreases in activity levels after retiring. The findings are not conclusive however. For example, manual versus non-manual men saw a similar magnitude of percentage decrease (28.5% vs 28.1% respectively, adapted from Tables 2 and 3 of Barnett et al). The categorisation into manual and non-manual work used by Barnett et al was presumably selected as numbers would have been too low to allow a more granular definition. The approach is justified, but has the unfortunate by-product of proxying occupational physical activity meaning that these groups were more physically active before retirement.
1
Primary Care and Public Health, Imperial College London, London, UK; 2Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK Correspondence to AA Laverty, Primary Care and Public Health, Imperial College London, London W6 8RP, UK; [email protected]
Nevertheless, perhaps the main gap in our knowledge is how to increase levels of physical activity in older adults. Barnett et al cite a study using the English Longitudinal Study of Ageing, which found that persons about to retire may be particularly receptive to behaviour change.7 This study examined rates of smoking cessation among those aged over 50 years and found that those who retired were more likely to quit than those who stayed in employment (42.5% vs 29.3%). The applicability of these findings to other behaviours such as physical activity is not known, but more work in this area would be beneficial. Retirement is widely acknowledged as a time of great potential for change, for example, moving house is common in the 12 months after retirement.8 What we do not know is whether people are likely to move to areas more or less conducive to physical activity. We do know, however, that what are traditionally thought of as non-health interventions can have an impact. The concessionary bus pass for those over the age of 60, for example, has been found to be associated with increases in walking and a lower body mass index among those with a bus pass.9 10 The bus pass has been provided in England since 2006 and allows those over 60 years old to use local buses free of charge outside of rush hour and was primarily aimed at preventing social exclusion.11 Again, the impact of the bus pass on overall levels of activity and on longerterm health outcomes is not known, but these findings provide evidence that the decline in physical activity is not an immutable phenomenon. There is a limited amount of research on encouraging physical activity in older adults. While there is indication that behavioural interventions may be effective in changing activity levels, it is not clear whether effects persist beyond 12 months.12 There is also no definitive evidence on whether certain modes of delivering interventions are more effective, which is likely to hamper efforts to increase activity levels.12 A meta-analysis concluded that levels of activity could be increased, but that challenges remain in developing interventions that are effective in generating more than modest changes.13 The study by Barnett et al also adds to our knowledge by providing the breakdown of physical activity across separate domains.
Laverty AA, et al. J Epidemiol Community Health August 2014 Vol 68 No 8
It is apparent that when working, occupation makes up a substantial proportion of physical activity. This highlights the substantial ground to be made up and presents the possibility that certain domains of activity may be easier to encourage among this age group, although again this is not fully understood. Barnett et al have classified retirement using a combination of self-reported items: whether respondents reported any paid work in the previous work and whether they reported any occupational physical activity. This thorough approach means we can be confident in the ‘retired group’ being ‘completely retired’. The authors also correctly acknowledge the increasingly complex conceptualisations of retirement, which is by no means a binary phenomenon.14 For example, effects of retirement have been shown to vary according to whether people retire voluntarily or in response to ill health.15 16 It is also possible that many people of this age may transition from full-time to part-time work as a prelude to full retirement, and we may need to know more about whether there are differential effects here. Analyses of the British Household Panel Survey have found that while health shocks can predict early retirement, having a partner who remains employed reduces the chances of retiring.17 Extrapolating this to physical activity, perhaps we should consider whether the employment status and activity levels of older adults are sometimes better considered in a couple, and perhaps this is the appropriate unit for any interventions to increase levels of physical activity. In conclusion, the recent study by Barnett et al is important and adds to our knowledge of changes in physical activity across the lifecourse. Despite caveats and remaining uncertainty, there is now enough evidence to support targeting those about to retire with health-enhancing interventions, including efforts to increase physical activity. Future research should investigate whether certain subgroups may be particularly amenable to change; whether particular domains of activity are more readily modified; and how this could be best achieved. Contributors AAL and EF planned, wrote and edited the paper equally. Both authors approved the final version for submission. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
701
Downloaded from http://jech.bmj.com/ on December 6, 2017 - Published by group.bmj.com
Commentary To cite Laverty AA, Flint E. J Epidemiol Community Health 2014;68:701–702. Received 12 March 2014 Accepted 3 April 2014 Published Online First 29 April 2014
3
4
5
▸ http://dx.doi.org/10.1136/jech-2013-203225
6
J Epidemiol Community Health 2014;68:701–702. doi:10.1136/jech-2014-204149
7
8
REFERENCES 1
2
702
Barnett I, van Sluijs E, Ogilvie D, et al. Changes in household, transport and recreational physical activity and television viewing time across the transition to retirement: longitudinal evidence from the EPIC-Norfolk cohort. J Epidemiol Community Health 2014;68:747–53. Godfrey A, Lord S, Galna B, et al. The association between retirement and age on physical activity in older adults. Age Ageing 2013; doi:10.1093/ageing/ aft168 [ published Online First: Epub Date].
9
10
Berger U, Der G, Mutrie N, et al. The impact of retirement on physical activity. Ageing Soc 2005;25:181–95. Slingerland AS, van Lenthe FJ, Jukema JW, et al. Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study. Am J Epidemiol 2007;165:1356–63. Barnett I, van Sluijs EMF, Ogilvie D. Physical activity and transitioning to retirement: a systematic review. Am J Prev Med 2012;43:329–36. Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012;80:247–57. Lang IA, Rice NE, Wallace RB, et al. Smoking cessation and transition into retirement: analyses from the English Longitudinal Study of Ageing. Age Ageing 2007;36:638–43. Evandrou M, Falkingham J, Green M. Migration in later life: evidence from the British Household Panel Study. Office for National Statistics. Population Trends, 2010. Webb E, Netuveli G, Millett C. Free bus passes, use of public transport and obesity among older people in England. J Epidemiol Community Health 2012;66:176–80. Coronini-Cronberg S, Millett C, Laverty AA, et al. The impact of a free older persons’ bus pass on active travel and regular walking in England. Am J Public Health 2012;102:2141–8.
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Department for Transport. Improving local transport, concessionary bus travel. Secondary Department for Transport. Improving local transport, concessionary bus travel. https://www.gov.uk/government/policies/ improving-local-transport/supporting-pages/ increasing-the-use-of-buses Hobbs N, Godfrey A, Lara J, et al. Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med 2013;11:75. Conn V, Valentine J, Cooper H. Interventions to increase physical activity among aging adults: a meta-analysis. Ann Behav Med 2002;24:190–200. Denton FT, Spencer BG. What Is Retirement? A Review and Assessment of Alternative Concepts and Measures. Can J Aging 2009;28:63–76. Jokela M, Ferrie JE, Gimeno D, et al. From midlife to early old age: health trajectories associated with retirement. Epidemiology 2010;21:284–90. Stenholm S, Westerlund H, Salo P, et al. Age-related trajectories of physical functioning in work and retirement: the role of sociodemographic factors, lifestyle and disease. J Epidemiol Community Health 2014;68:747–53. Jones AM, Rice N, Roberts J. Sick of work or too sick to work? Evidence on self-reported health shocks and early retirement from the BHPS. Econ Model 2010;27:866–80.
Laverty AA, et al. J Epidemiol Community Health August 2014 Vol 68 No 8
Downloaded from http://jech.bmj.com/ on December 6, 2017 - Published by group.bmj.com
Retirement and physical activity A A Laverty and E Flint J Epidemiol Community Health 2014 68: 701-702 originally published online April 29, 2014
doi: 10.1136/jech-2014-204149 Updated information and services can be found at: http://jech.bmj.com/content/68/8/701
These include:
References Email alerting service
This article cites 13 articles, 3 of which you can access for free at: http://jech.bmj.com/content/68/8/701#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
