Background: Physical activity had important role in promoting aging health. Various factors have effect in physical activity level elderly that increase the active rate.
Objectives: The current study aimed to relationship evaluated physical activity and facilitate factors in the elderly Kashan /Iran 2014.
Methods and Materials: This is descriptive cross-sectional study. Sample were 400 elderly (aged more than 60 years) living in Kashan city of Iran in 2014. The subjects selected in multistage cluster sampling. Subjects were randomly selected from healthcare centers in 3 regions Kashan. The sample size were different according gender and area living. The demographic characteristics, level of physical activity and Active Benefits/Barriers Scale recorded were in the questionnaire. Data analyzed by SPSS version 16. Descriptive statistics, chi-square test and Pearson correlation, T test, and ANOVA used in data analysis. The significance was level for all the tests considered p<0.05.
Results: The 237 (59.2%) of subjects were female. The average ages of the study population were 67.6 ±6.8 years. Average physical activity energy consumption in elderly was 326.21±364.84 according to metabolic equivalent Hours per week. The 20 subjects (5%) reported no physical activity. The 320 (80%) and 59 (14.8%) subjects had low and moderate physical activity level respectively. Only 1 subject (0.2%) had extreme physical activity. Attitude facilitates factors score were 70/82±18/27. The most facilitate factors relate to cardiovascular systems health (88 subjects). There are significant relation between facilitates factors score and physical activity levels) Chi-square=19/91, p=0/0001), age (p=0.001 r=0/01), gender (p=0.002), marital status (p=0.0001), educational status (p=0.001), personal independence (p<0.0001) and BMI status (p=0/00001).
Conclusion: Various factors related to active facility in elderly. Consideration these factors are essential in programs for physical activity elderly. In addition, the promotion of active life should be a part of health care planning in elderly.
Keywords: Physical activity, aging, facilitate, factor
1. Background
Physical activity is one infrastructure program in public health that attention has been to growing trend(1). The appropriate physical active level one of the important components of health especially in the elderly introduced World Health Organization(2). That maintained should be the time of death. (3). Physical activity is the definition every move, the activities body by skeletal muscle. The action increase total energy consumption. These activities are in aging including the workplace, taking care of their own, household, transport and leisure activities(4).The physical active role play effect in fitness, improve body balance, muscle strong and mental health function(5, 6). So relationship having with promote health and social function(3). Increase self-esteem, improving self-body image, enjoying the mobility, reducing the stress and depression is other affections on the elderly(7, 8).
Lock physical activity is one of public health problems(6). This behavior has caused common chronic diseases that threat individual’s health(9). The physical active is important early risk factor in mortality rates. (10). Reduce physical activity has effect in creating osteoporosis, diabetes type colon cancer and cardiovascular diseases during retirement aging(11). So role play in preserving the independence of the individual, reduce physical disabilities and improvement muscular disorders(12, 13). According to the Center for Disease Control and Prevention study of America in 2007, had regular physical activity only 14% of individuals aged 65- 74 years and 7% of people over 75 years old(14). Statistical differences of activity ageing level inducted role-play multiple factor in lock physical active elderly. The improvement conditions, the situation, to encourage and facilitate the physical activity(15). The physical activity facilitator factors are task, conditions and individuals affect cases to encourage and facilitate the physical activity for more energy consumption and movement skeletal muscle(7).
Rimmer et al (2008) showed the most important physical activity facilitator factors in cerebral stroke elderly were the cost financial of physical activity, the awareness of the centers physical active in the region, fitness and increase motivation(16). In the Gobbi et al study (2009) willable access to amenities, positive physical activity perceptions, and existing habit of being active were the highest impact facilitators(17). Hanley et al (2011) in US showed that supplement facilities social is one of the facilitating activities factors elderly(14). The improve condition social environment is important facility factors in the Bjorsdo et al (2012) studies(18).The most physical active facility factor among African American elderly was improved motivation and physical health(19). The study Iranian in 2010 showed the most important facility factor Tehran elderly related to meet with more people, friends, and funny(20). Another study among Swedish elderly men mentioned Enjoyment and maintaining health were important physical activity facility factors(15, 21).
The physical active among elderly is different levels according to biological factors, age, psychological status, enjoy during active, behavior characterizes, supplement social, environment factors and access physical activity equipment(5, 22). Physical activity is a crucial part of lifestyles programs in health care(23). Social, cultural and climate Conditions influence the patterns of physical activity in every region. Evaluation of physical activity facility factors in different regions can provide important data for health planners and experts interested in healthy aging issues.
2. Objectives: The current study aimed to relationship evaluated physical activity and facilitate factors in the elderly Kashan /Iran 2014.
3. Materials and Methods
3.1 Study population and sampling
In this cross-sectional study in 2014, the physical activity in elderly and its related factors studied. The study population included 400 elderly aged over 60 years who had health care records in health centers in Kashan city. Kashan is a warm and dry city located in the edge of great desert in the center of Iran and city has about 200000 populations. According to previous study and estimation of inactivity in 87% of the elderly(20), confidence level of 95% (d=0.05, p=0.87, z=1.96) the sample size was calculated to be 261 according to Cochran formula. It increased to 1.5 fold due to cluster sampling, and finally 400 Individuals investigated. Inclusion criteria were age over 60 years, the Iranian nationality, no history of recognized mental disorders (psychosis), and dementia, the ability to communicate and respond to questions and residing in Kashan city in the time of the study.
After coordination with the Department of Health and Medical Education and obtaining necessary permissions, the Kashan city divided into 5 regions (center, north, south, west, and east) based on health map. The 3 regions selected randomly. All health care centers in these areas entered to the study. In each health care centers, the elderly were determined from family records and the subjects selected randomly based on the population covered by the center. The selected subjects evaluated by telephone calls. If did not meet the inclusion criteria or were reluctant to participate in the study, another subject replaced randomly. If the questionnaire had some missing data, the researchers contacted to the subject to complete the items and if it was not possible, another subject replaced randomly. Then the researchers went to the houses of the subjects and after explaining the objectives of the study, the questionnaire completed. In elderly who did not have the ability to read and write the questionnaire completed through interview.
3.2. Questionnaire
The first part of the questionnaire contained demographic data including variables (such as age, sex, education, marital status, occupational status, location, and income). Ability of mobility, chronic diseases, and history of participation in regular physical activity also recorded. The second part of the questionnaire contained 24 items about different physical activities and duration of these activities that elderly usually perform in a week. The Iranian version of International Physical Activity Questionnaire (IPAQ) was used in this part (24). The energy consumption of every subject calculated according to the type of the activities and duration of the activities during a week in minutes. The activities divided to light (equivalent 1.3 units of energy per minute), walking (the equivalent of 3.3 units of energy per minute), moderate (equivalent to 4 units of energy per minute), and vigorous (equivalent to 8 units of energy per minute). The energy consumption of activities added to calculate the whole energy consumption in a week.
(The energy consumed amount based on the type of activities × minutes × days)= The amount of energy consumed within a week
For example, a person who spends 30-minutes a day for 5 day in week in walking and in moderate, vigorous physical activities has the total amount of energy consumption of 2295 [(8×30×5)+(3/3×30×5)+(4×30×5)] Unit Energy per week or metabolic equivalent rate (MET). The lowest possible score of the questionnaire is zero and the highest possible score is when someone practices the non-stop vigorous physical activity the whole of the week that is not attainable, so the upper limit is wide and has not defined.
There were four classes of physical activity. The Lack of physical activity, means reporting no activity during the week. The Moderate physical activity means having 600-1500 Unit Energy consumption per week. Vigorous physical activity means having more than 1,500 Unit Energy consumption per week and Low physical activity are people who cannot be classified in other groups(25).The IPAQ is a standard questionnaire. the mean of CVI and CVR of this questionnaire(26), has been reported 0.85 and 0.77 respectively, and its Cronbach’s Alpha coefficient had been 0.7(24). Its use was for elderly confirmed by 10 experts and in a pilot study in 30 elderly people the alpha-cronbach calculated 0.83.
Tree part of the questionnaire-contained questionnaire contained Active Benefits/Barriers Scale provided by Sechrist et al. The Active Benefits/Barriers Scale (ABBS) had 43 questions. The ABBS determine benefits and barriers to participating in physical activity from the literature and interviews. The instrument scored Likert-type format with response. This tool can be completed with the options strongly agree (score 4), agree (score 3), strongly agree (score 4), disagree (score 2) and strongly disagree (score 1). The total score ABBS is range from 43 to 172. The tool has not cut point. The Benefite score range is, 29 to 116. Missing data concluded if the items not answered more than five percent, recommended that the response discarded. The questionnaire result evaluated by test-retest reliability. The Iranian version of ABBS is a standard questionnaire, the mean of CVI and CVR of this questionnaire has been reported 0.81 and 0.76 respectively, and its Cronbach’s Alpha coefficient had been 0.87(27, 28). Its use was for elderly confirmed in 30 elderly people the alpha-cronbach was calculated 0.79. The Cronbach’s Alpha coefficient physical active facility factors questions had been 0.85.
3.3. Ethical considerations
The study proposal confirmed the research council university medical Sciences of kashan. The code of ethical was 197 in 25/5/2014. After receiving the necessary authorizations, oral and written consent obtained from participants. They assured that the data would remain confidential and used for the research purposes only. The participants were also given an unconditional an absolute right to withdraw from study at any time. All the subjects received explanation about the objectives of the study and they signed the informed consent.
3.4. Data analysis
The data analyzed by SPSS version 16. The normality of the data analyzed by Kolmogorov-Smirnov test and Q-Q normality plot. The variables of MET, age, facility score and BMI were not normally distributed, the non-parametric tests used for data analysis. The relationship between age, facility score and MET determined with Spearman correlation test. The qualitative variables relationship such as gender, marital status, education, physical activity level, facility factors and the disease evaluated chi-square test. The relationship between facility score and qualitative variables relationship such as gender, marital status, education, physical activity level evaluated ANOVA and T test. The significance level in all the tests considered p<0.05.
4. Results
Most participants were female (n = 237) (59.2 %). The mean age of the study population was 67.6 ± 6.8 years (range 60-90 years, median=65, Interquartile R (IQR) =8). Majority of participants were married (n = 291) (72.8 %).The 188 (28.5 %) subjects were illiterate. Most of the elderly (n = 199) reported housekeeper as their job. The 132 subjects (29.8%) were economically dependent to others. The 310 individuals (77.5 %) could walk without any assistive device. The 337 participants (84.2%) were living in villa houses. 300 participants (75%) had chronic diseases. Majority of participants tended to perform physical activity in the morning (n =221) (55.2%). 325 (81.2%) subjects reported no regular physical activity.
The mean physical activity energy expenditure in elderly of Kashan was 326.21± 364.84 MET/week (range 0-4899, median=222, IQR=366). The 20 (5%) subjects reported no physically activity and 320 participants (80%) had low physical activity. The 59 subjects (14.8%) had moderate physical activity and only 1 subject (0.2%) reported vigorous physical activity level which was removed from data analysis. (Table 1)
Table 1: The Physical activity Status in elderly of Kashan and other variables
Lack of activity Low activity Moderate activity Category
12 (4.2 %) 240 (81.6 %) 41 (14.2 %) 60-70 age
7(9.1%) 59(76.6%) 11(14.3%) 71-80
1(3.4%) 21(72.4%) 7(24.1%) 81-90
7(4.3%) 113(69.3%) 42(25.8%) Men gender
13(5.5%) 207(87.3%) 17(7.2%) Female
1 (0.3 %) 241(83.1%) 48(16.6%) Married Marital Status
19 (17.4%) 79(72.5%) 11(10.1%) Single
12(6.4%) 161(85.6%) 14 (7.4%) Illiterate Education
7(4.1%) 129(76.3%) 33(19.5%) Primary
1(2.3 %) 30(69.8%) 12(27.9%) Above high school
1 (1.9 %) 26(48.1%) 26(48.1%) active Current job
19(5.5%) 294(85%) 33(9.5%) Non active
4(1.3%) 248(80%) 57(18.4%) Independent Independence State
1(1.7%) 58(98.3%) 0 Using mobility assistive device
15(48.4%) 14(45.2%) 2(6.5%) Disability
3 (4.8 %) 45(71.4%) 15(23.8%) Apartment house Location
17(5%) 275(81.6%) 44(13.1%) Villa house
19 (6.3%) 240 (80 %) 41(13.7 %) yes Chronic Disease
1 (1 %) 80(79.2%) 18 (18.8%) no
5(4.8%) 82 (77.4%) 18 (17.8 %) Under 25 BMI
14(6.5%) 172(79.6%) 30(13.9%) 25-30
1 (1.3 %) 66(84.6%) 11 (14.1%) Up 30
The facility factors score in physical active elderly Kashan were 70/82±18/27 with minimum score 33, maximum 105 and median 75. Facilitate factors score women were more than men do. Marital elderly had more score than single elderly. The attitude physical active facilitate factors score were more in living village house elderly. In addition, elderly with underline chronic disease had more score. Individuals with higher education were more score compare to illiterate persons. The employed individuals had lower score than unemployed. The attitude facilitates factors physical active score were more in Independent elderly. (Table 2)
Table 2: relationship and mean facility factors score in physical activity elderly of Kashan and other variables in 2014
P value Z Mean Rank Mean Category
0/002 -3/113 215/41 63/43±1798 Men gender
178/82 73/15±18/13 Female
0/0001 -6/47 223/38 74/63±16/27 Married Marital Status
139/41 60/66±19/44 Single
0/001 Chi-square=15/126 200/75 71±17/55 Illiterate Education
184/71 68/36±17/93 Primary
261/45 79/69±20/17 Above high school
0/0522 -1/94 172/13 66/46±19/34 active Current job
204/93 71/5±18 Non active
0/0001 Chi-square=33/194 214/96 73/24±17/8 Independent Independence State
180/75 68±16/7 Using mobility assistive device
93/45 51/9±13/5 Disability
0/312 -1/012 186/98 67/88±21/88 Apartment house Location
203/03 71/37±17/49 Villa house
0/711 -0/37 201/74 70/96±17/6 yes Chronic Disease
196/8 70/42±20/2 no
0/0001 Chi-square=30/439 253/26 78/33±18/87 Under 25 BMI
179/03 67/28±18/17 25-30
188/25 70/42±14/44 Up 30
According to table 3 the most facilitates factors were in physical active elderly Kashan related to cardiovascular systems function health (88 subjects). Lazy decrease (59 subjects) and Independent health were next the most physical active facilitates factors elderly.
Table 3: Frequency and percentage facility factors physical activity elderly Kashan in 2014.
Completely agree agree Completely disagree disagree
Enjoyment of physical activity 49(12/2%) 182(45/5%) 80(20%) 89(22/2%)
Reduce the anxiety and stress 39(9/8%) 244(61%) 276/8%) 90(22/5%)
better mental health 37(9/2%) 250(62/5%) 32(8%) 81(20/2%)
Equipment supplement 45(11/2%) 210(52/5%) 22(5/5%) 123(30/8%)
The availability of appropriate facilities to suit the tastes 34(8/5%) 162(40/5%) 100(25%) 104(26%)
meeting with friends 30(7/5%) 191(47/8%) 80(20%) 99(24/8%)
Prevent hypertension 46(11/5%) 190(47/5%) 48(12%) 116(29%)
maintain fitness 21(5/2%) 191(47/8%) 86(21/5%) 102(25/5%)
Improve the functioning of the cardiovascular system 88(22%) 245(61/2) 23(5/8%) 44(11%)
Increase body strength 35(8/8%) 166(41/5%) 126(31/5%) 72(18%)
Improve the physical problems 29(7/2%) 173(43/2%) 109(27/2%) 89(22/2%)
Knowledge of sports facilities around 16(4%) 178(44/5%) 59(14/8%) 147(36/8%)
Learn more lifetime 51(12/8%) 256(64%) 4(1%) 89(22/2%)
Reduce fatigue 30(7/5%) 139(34/8%) 102(25/5%) 129(32/2%)
meet new people 32(8%) 142(35/5%) 91(22/8%) 135(33/8%)
Security in the neighborhood 32(8%) 188(47%) 88(22%) 92(23%)
Support from government agencies 26(6/5%) 219(54/8%) 42(10/5%) 113(28/2%)
Fun with activities 39(9/8%) 202(50/5%) 25(6/2%) 134(33/5%)
Improve the quality of jobs 28(7%) 206(51/5%) 33(8/2%) 133(33/2%)
There is interest in doing 37(9/2%) 188(47%) 73(18/2%) 102(25/5%)
increasing acceptance of the others 39(9/8%) 187(46/8%) 54(13/5%) 120(30%)
independence and reduce dependence 57(14/2%) 236(59%) 35(8/8%) 72(18%)
Reduce Lazy 59(14/8%) 218(54/5%) 35(8/8%) 88(22%)
Higher self-esteem 32(8%) 248(62%) 50(12/5%) 70(17/5%)
Tests showed significant relationship between the attitude physical active facilitates factors score and physical activity level) Chi-square=19/91, p=0/0001), age (p=0.001 r=0/01), sex (p=0.002), marital status (p=0.0001), educational status (p=0.001), personal independence (p=0.0001) and BMI status (p=0/00001). (Table 2)
5. Discussion
The results study evaluated relationship physical activity and facilitates factors in the elderly Kashan. According to finding, 85% of elderly in Kashan/Iran had low or no physical activity. Loland, et al (2004) reported low level of physical activity in elder population(29). In addition, paradox relationship showed between age and physical active rate(30). The results study indicated that women had lower physical activity than men did. In Iran 2010, the study showed men elderly Tehran had lower physical activity than women did(20). Kurozawa et al (2005) reported that women were more active than men elderly china(25). The low physical activity in women in current study may reflect the reality that women were more engaged in house hold activities. These activities mostly considered are as low-level physical activities and are not sufficient for adequate energy expenditure in elderly. On the other hand, men were more active in moderate activities. According to active theory, elderly like in aging were active. So tried had maintain past physical active levels. Furthermore, continue theory pointed out the personality in the ageing remains constant. People follow a behavior pattern. Men maintain previous activity pattern in aging.
The most physical active facilitates factors in current study were in elderly Kashan related to cardiovascular systems function health. Similarly, result reported in other study(31). The study Iranian in 2010 showed the most important facility factor Tehran elderly related to meet with more people, friends, and funny. Other factors were including improved mental function, decrease weight and biter sleeping(20). Resnick et al (2000) reported the most physical active facility factors elderly was fitness, decrease stress and promotion health(30). Newson et al (2007) reported the most physical active facility factors elderly was important to his/her health(32). In other study said the aimed the facility factor in physical active are improve the quality of life of elderly persons(33). Furthermore, the result current study indicated other facility factors are enjoying of physical activity, longer lifetime, and equipment supplement in participation elderly. Evaluation various physical active facility factors elderly showed the facility factors are important in aging that influence in promote health elderly.
In this research, there are significant correlation between the physical activity facility factors score and gender. Similarly result found other study(34) .Also Salehi et al (2010) found the same results in Tehran/Iran (20). The low physical activity facility score in men in current study may reflect the reality that women were more engaged in house hold activities. These activities are consider mostly as low-level physical activities and are not sufficient for adequate energy expenditure in elderly. The conditions these actives are available for women’s elderly. On the other hand, men were more active in moderate activities. The men elderly had in supply previous physical active more challenges
The results of this study indicated significant relationship between physical activity facility score and marital status. Marital elderly had most score than singles did. Although Hekmatpou et al (2012) in Arak/Iran reported that not indicated significant relationship between physical activity facility score and marital status(35). Henderson et al (2003) showed Social support family members, spouses and other individuals related to the positive encourage effects in participate physical active and health programs .the result this act is enhance movement. Married individuals wider relationship compared to single people that may increase their activities(36).
Individuals with higher education had more facility factors score compare to illiterate persons. Hekmatpou et al (2012) did not found relationship between physical facility score and educational status in elderly. Although had different, the kinds of activities among different educations individuals. Level can influence knowledge about physical activity and the personal hobbies. In addition, these actives related to leisure and household activities than do not require education(35).
The depended individuals had lower physical activity facility score compare to independence individuals. The score indicate independence elderly having more condition that is desirable in physical active. Persons with depended conditions experience limitations in mobility or have behavioral disorders. These limitations can negatively affect self-care and activity levels if appropriate accommodations or supports are unavailable(37). Therefore the independence personal is important factors for elderly in having physical active(5).
5.1. Limitations and strengths: The tool that we used in this study has some limitations. It has many items and relies on the memory of the elderly that can increase the risk of under or over estimation of physical activities. We tried to overcome this problem by interviewing the patients. There are some items in the questionnaire that elderly does not engage so often. This may cause some floor effect of the questionnaire. As it can seen most of the subjects reported the lowest physical activity and even lack of physical activity. This study also has some strength, first this is one of the limited studies available about the physical activity in the community-based population of the elderly. Second, it gives a concrete and helpful data about the type of activities that elderly usually engage. This study can provide necessary information for future planning of physical activity improvement in elderly.
6. Conclusion
The results of this study showed the type of gender, marital status, to the independence of the individual, the level of education and the characteristics of the body mass index are variables affecting in physical active facility factors Kashan elderly. the most important facilitates factors to encourage in Kashan elderly was related to cardiovascular function systems health .evaluate facility factor in elderly is more important compare to other age groups. Through Consideration these factors and conditions is essential in programs for physical activity in elderly. In addition, the pattern of physical activity in elderly depends on their life style. The promotion of active life should be a part of health care planning in elderly.
Acknowledgment
This paper derived from the M.Sc. thesis in Kashan University of Medical Sciences. The authors wish to thank the elderly who participated in the study.
Conflict of Interest
The authors declare no conflict of interest in this study.
Authors’ Contribution
Ali Sadrollahi performed the data collection, literature review, and prepared the first draft of the manuscript, supervised the study made critical revisions to the paper and prepared the last revision of the manuscript. Masoumeh Hosseinian performed the data collection, literature review, and prepared the first draft of the manuscript. Negin Masoudi Alavi supervised the study, performed data analysis. Zahra khalili helped in the process of sampling.
Financial Disclosure
University Medical Sciences of Kashan
Funding/Support
This study was part of a thesis in MS in critical geriatric nursing and funded by the Deputy of Research, Kashan University of Medical Sciences (KAUMS), Grant No: 9305.