Use it or lose it: a qualitative study of the maintenance of physical activity in older adults

Lack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65-74 years and 43% of males and 21% of females aged 75-84 years meeting PA recommendations. PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people.

Face to face semi-structured interviews were conducted with adults who completed one of two strength and balance exercise programmes as part of the ProAct65+ trial: group (FaME) and home based (OTAGO) exercises. Five GP practices in Nottingham and Derby were recruited and invited people aged 65 years and older who met eligibility criteria. Interviews were conducted in participants' homes. Interviews explored PA levels pre and post intervention, perceived health benefits, facilitators, barriers and use of technology for PA maintenance. The interviews were transcribed verbatim and analysed using framework analysis and the software NVivo10.

Fifteen participants from each intervention group were interviewed. The FaME group consisted of 10 females and 5 males, age range of 70-88 years. The OTAGO group consisted of 12 females and 3 males aged 72-95 years. Important themes identified were physical, social, psychological and environmental facilitators and barriers. These included increased physical autonomy, enjoyment, positive evaluation of the activity and physical benefits, importance of social interaction, positive feedback, development of behaviour considered normal or habitual, motivation and self-efficacy. Some participants used technologies not included in the original interventions, like pedometers and smart phones to motivate themselves.

A range of modifiable factors influence continued participation in PA at the end of exercise programmes. The findings from this study will inform the commissioning and quality improvement of future PA programmes and development of an intervention to enhance continuation of PA after exercise interventions in older adults.