Research Study on Elderly Citizens and their

Sports/Physical Activity Habits in UK

Sports Dissertation
Submitted by:

17
 Academic Research Study on Elderly Citizens and their Sports/Physical Activity
Habits in the UK

by

______________

A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE

Major: Exercise and Sport Science

to

University of ___________

2017

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Abstract

Introduction: Regular physical activity (PA) has been shown to be beneficial. A lower percentage of rural
compared to urban/metropolitan older adults participate in PA. Maintaining desired amounts of PA
among elderly individuals with limited access to community and health care facilities and other
psychological and environmental barriers is critical to public health . Thus, the purpose of this study was
to determine the individual, psychological and perceived environmental barriers and their correlation
with PA in rural and urban older adults

Methodology: After approval from the University, 150 survey questionnaires were distributed to older
adults attending stroke detection clinics organized at various locations within Bedfordshire and
Hertfordshire.

Results: Of the 150 surveys, 41 and 31 surveys were received from rural and urban locales respectively.
Land-use mix diversity, Physical Activity Self Efficacy, Social Support from friends and Competence
Motivation for physical activity were significantly higher (p<0.05) in urban subjects. Affective attitude
and Satisfaction With Life Score was significantly higher (p<0.05) among rural subjects. In the entire
cohort, PA was significantly correlated with Intention to Exercise (r = 0.46) ), Barrier Self Efficacy (r =
0.42) Satisfaction With Life Scale (r = 0.36), Physical Activity Self Efficacy (r = 0.34), Perceived Behavioral
Control (r = 0.28) and Instrumental Attitude (r = 0.20). When all correlates were entered into a
regression model, only Intention to Exercise (R2 = 0.213) was significantly associated with PA in the total
cohort. In the rural group, Barrier Self Efficacy, depression and Pros and Cons of exercise were
associated with PA (R2 = 0.511). Intention to exercise and education were associated with PA in the
urban sample (R2 = 0.390).

Discussion: The findings do not support locale to be associated with PA behavior in older adults residing
in Bedfordshire and Hertfordshire. The levels of PA were similar between urban and rural populations
under study. However, PA correlates differ between the urban and rural older adults and must be
considered when planning exercise intervention for respective groups.

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CHAPTER 1.

INTRODUCTION

Regular exercise and physical activity (PA) have been shown to be beneficial by mitigating the risk of
coronary heart disease, diabetes mellitus, obesity and other chronic diseases as well as improving mood,
decreasing anxiety and playing an important role in improving health related quality of life. Similar
beneficial effects have been well documented in older adults (U.S Department of Health and Human
Services, 1996). PA has an important role in helping older adults preserve independence, control weight,
and maintain muscle, joint and bone health (American College of Sports Medicine, 1998).

People over the age of 65 constitute one of the fastest growing population segments among
industrialized nations (U.S Senate Special Committee on Aging, 1987). They also have many of the
chronic health conditions which are preventable by physical activity (Berg & Cassel 1990). Exercise like
any other component of health care is bounded by physical, personal and environmental factors (Arcury
et al. 2006). These factors change from individual to individual and from one society to another.

Targeting these factors is as important as prescribing the precise intensity, duration and frequency of
exercise. In an industrialized country the population of older adults often gets divided into those living in
either urban or rural areas. The factors that promote and limit physical activity in these areas differ from
each other. While those living in urbanized cities frequently have excellent transport facilities and easy
access to health centers, their rural counterparts are often deprived of the same. Apart from the above
factors, lower education and socioeconomic level may also have an undue bearing on the mind frame of
the rural older adults.

According to The Centers for Disease Control and Prevention (CDC, 1998) a lower percentage of rural
compared to urban/metropolitan adults aged 65 to 74 years participated in leisure-time physical
activity. Women aged 40 years and older in rural areas were one third more likely to be physically
inactive than were their urban counterparts (Brownson et al., 2000). When compared to urban adults,
rural women especially those who were educated and lived in the South, were more sedentary (Wilcox,
Bopp, Oberrecht, Kammermann & McElmurray, 2000). Our review of literature suggests that few studies
have focused on determining the correlates of physical activity in the rural elderly population. One such
study assessed psychological and perceived environment correlates of PA in rural older AfricanAmerican

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and White women residing in Fairfield County, SC which is more developed as compared to Mid-
Western Bedfordshire and Hertfordshire (Wilcox et al. 2000). Maintaining required amounts of PA
among elderly individuals with limited access to community and health care facilities and other
psychological and environmental barriers is critical to preserve function, independence, quality of life. It
should be a public health priority. Thus, the purpose of this study is to determine individual,
psychological and perceived environmental barriers and their correlation with PA in rural and urban
older mid-western adults.

AIM AND RESEARCH QUESTIONS

The aim of this thesis is to describe and analyze the information services for caregivers on the meaning
of outdoor physical activities for the elderly. Studies used in the literature review of this thesis include
older people health, the importance of been active and the cost of inactivity among the elderly people.

The writer clarify the careers and institutions role on how to engage the elderly in physical activity and
the role of the public infrastructure such as the recreational areas where the elderly are free to engage
in outdoor exercise.

In addition, the writer interest and goal of this thesis is to advance and create full awareness about the
present situation of knowledge on the careers and institutions. The writer narrows the research
questions, and the result of the literature review will answer the questions which lead to research
findings and conclusions

Research question 1 What are the benefits of physical activities for the elderly?

Research question 2 What is the impact of physical activity on health promotion, quality of life, and
mental health?

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CHAPTER 2.

LITERATURE REVIEW

Introduction

Exercise or participation in regular physical activity is a behavior influenced by a myriad of factors.

Understanding these factors is vital for an individuals long term participation in a routine exercise
program. Health promotion campaigns are often aimed at changing beliefs or knowledge on the
assumption that such changes are necessary to bring about a change in behavior. Unfortunately,
changes in awareness, attitudes, beliefs and knowledge about exercise do not guarantee changes in
exercise behavior (Biddle & Mutrie, 2008). A number of theoretical models have been proposed that
attempt to explain the association of these myriad factors with exercise. These will be briefly described
here

Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB)

The Theory of Reasoned Action, as proposed by Ajzen and Fishbein, is based on the assumption that
intention to perform a behavior is an immediate determinant of the behavior (Ajzen, 1988). Intention
refers to the extent to which a person plans, is determined or has decided to perform the
behavior (Hausenblas, Carron, & Mack, 1997). Intention, in turn, is predicted from the two constructs of
attitude and subjective normative factor. Subjective normative factor or subjective norms refer to the
perceived social pressures to perform the behavior. Subjective norm is a combination of perceptions
about the expectations of important others (e.g. family, friends, etc.) and motivation to comply with
those expectations (Hausenblas, et al., 1997).

The theory has been extensively used in studies researching physical activity behavior. A meta analysis
of 31 exercise studies yielded 162 effect sizes and found that intention had a large effect on exercise
behavior (ES=1.09, SD=0.7, r=0.47) and attitude had a large effect on intention (ES=1.22, SD=0.5, r=0.52).
The effect of attitude on intention was twice that of subjective norm (ES=0.56, SD=0.7, r=0.27). A
significant difference was also seen between the relationship of attitude and exercise (ES =0.84) and
between subjective norm and exercise behavior (ES=0.18). Thus, subjective norm is useful in predicting
intention to exercise and a direct predictor of exercise behavior (Hausenblas, et al., 1997). Thus TRAs

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attitudinal component appears to be influential in predicting intentions to be physically active but, on
the other hand, the TRA seems to omit other potentially important determinants of action, such as
environment and health influences.

Ajzens TRA was insufficient for explaining behaviors where volitional control is incomplete and where
resources and skills are required. Ajzen proposed an extension of the TRA for such behaviors with an
additional variable of perceived behavioral control. Perceived behavioral control was defined by Ajzen as
the perceived ease or difficulty of performing the behavior and was assumed to reflect past
experience as well as anticipated impediments and obstacles (Ajzen, 1988). Thus, inclusion of perceived
behavioral control in the TPB helped reveal the personal and environmental factors that affect behavior
(Ajzen 1985). The TPB has been extensively used in the study of physical activity. Physical activity is a
behavior with many barriers and frequently little volitional control. A meta-analysis of 72 studies
(Hagger, Chatzisarantis, & Biddle, 2002) indicated that intention was the only direct predictor of
behavior (r=0.51). Intention was predicted more strongly by attitudes (r = 0.60) than subjective norms (r
= 0.32) and Perceived Behavioral Control (r=0.57) was associated with behavior through intention.

The Transtheoretical Model (TTM)

According to the TTM, recovering from problem behaviors or successful behavior change involves
movement through a series of stages (Prochaska, DiClemente, & Norcross, 1992). The various stages of
change include precontemplation (are not currently physically active and have no intention of doing so
in the near future) and contemplation ( not currently physically active but who have an intention to start
in the near future). Individuals in the next stage, preparation, according to Marcus and Simkin (1994) are
individuals who are currently exercising some, but not regularly. The action stage represents people
who are currently active, but have only recently started. The last stage is the stage of maintenance. It
includes those who are currently physically active and have been for some time, usually at least six
months (Biddle & Mutrie, 2008) .

A recent study located differences within a stage. Three subgroups of contemplators existed: early and
middle contemplators, and those in pre-preparation. Early contemplators are viewed as individuals who
have low self-efficacy, view few benefits and many disadvantages of exercise and are at risk of
regression. Middle contemplators are individuals with low self-efficacy and approximately equal pros
and cons towards exercise. Individuals in pre-preparation are those who are ready to move to the next
stage (i.e., stage of preparation), elicit high self-efficacy and report low disadvantages of exercise. Thus

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with its various stages, the transtheoretical model helps delineate change in adoption of health related
behavior.

The TTM assists individuals in making transitions across the various stages of change in exercise related
health behavior (Prochaska & Marcus, 1994). The transtheoretical model states that stage transition
results from stage-specific cognitive and behavioral process. According to Kim (2008), cognitive
processes obtain information from an individuals own actions while information for behavioral
processes is obtained from environment events. People at different stages of change are hypothesized
to use distinct processes of change. In a study detailing the association of stage and processes of change
with adoption and maintenance of muscular fitness-related behavior, Cardinal & Kosma (2004) observed
cognitive processes to peak in the contemplation stage while behavioral processes steadily increased
from the precontemplation to maintenance stage at which point the behavioral processes leveled off.

Stage-match intervention uses the main constructs of the TTM and is matched to the individuals stage
of readiness for exercise behavior (Kim, 2008). Hence, stage-matched interventions use different
strategies and techniques based on the stage the individual is in to bring about effective changes in
exercise behavior. A recent study on Type 2 diabetics in South Korea (Kim, Hwang, & Yoo, 2004)
compared a stage-based intervention with regular physical activity education advice. The stage based
intervention included stage matched counseling strategies based on the main constructs of the TTM
such as processes of change (POC), self efficacy (SE) and decisional balance (DB) along with individual
exercise prescription and telephone counseling. Significant increases in overall stage of change (SOC)
and physical activity levels were noted in the stage matched intervention group. A higher percentage
(77.4 %) of the participants progressed from baseline in the intervention group as opposed to only 4.3%
in the control group. Similar increases in SOC and physical activity have been observed in other studies
comprising of urban older adults (King, Pruitt et al., 2000) and in younger adults in a worksite setting
(Marcus & Simkin, 1994).

Social Cognitive Theory

The social cognitive theory (SCT) was developed in the 1980s by Albert Bandura. According to Bandura
(2004), the social cognitive theory specifies a core set of determinants, the mechanism through which
they work and the optimum ways of translating this knowledge into effective health practices. The core
determinants for effective health practices of individuals include knowledge of health risk and benefits
of different health practices, perceived self efficacy, outcome expectations, health goals people set for

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themselves and perceived social and structural facilitators. Bandura (2004) states that change in health
behavior requires motivation and self- regulation. People must learn to monitor their health behavior,
motivate themselves, set goals and establish social support to sustain their effort. Strategies to increase
social support and self-regulatory skills have been highlighted by Nahas, Goldfine, & Collins (2003) in
their report on determinants of physical activity in adolescents and young adults. A recent intervention
study by Ince (2008) using the social cognitive concepts as explained by Bandura (2004) and Nahas, et al.
(2003) on 62 undergraduate students resulted in significant improvements in exercise behavior and
other benefits like health responsibility, nutrition, social support and stress management.

Self efficacy, a key construct of social cognitive theory, is defined as peoples judgments of their
capabilities to organize and execute courses of action required to attain designated types of
performances. It is concerned not with the skills one has but with judgments of what one can do with
whatever skills one possesses (Bandura, 1997). Bandura (1986) listed four sources of efficacy
information, namely prior success and performance attainment, imitation and modeling, verbal and
social persuasion and judgments of physiological states. Schwarzer (1992) stated self-efficacy to be a
very powerful behavioral determinant and its inclusion in theories of health behavior therefore is
warranted.

Hofstetter, et al. (1991) found self-efficacy to predict walking in a large adult community. Similarly,
Sallis, et al. (1992) have shown self-efficacy to predict exercise change over time. McAuley & Blissmer
(2000) state that the relationship between self-efficacy and physical activity is complex. Self-efficacy
beliefs are likely to be more influential in conditions that are challenging in comparison to situations that
are more habitual and require less effort. 25B.

Self Determination Theory

Deci and Ryan (1985) proposed the self determination theory. It is a macro-theory of human motivation
concerned with the development and functioning of personality of social contexts. According to Deci
and Ryan (1985), the theory focuses on the degree to which people endorse their action and engage in
actions with a full sense of choice. The theory also suggests human beings are active organisms, with
innate tendencies toward psychological growth and development, who strive to master ongoing
challenges and to integrate their experiences into a coherent sense of self. In order to function
effectively and overcome challenges, human beings must be able to satisfy the three basic psychological

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needs of individual competence, autonomy and relatedness. According to Deci and Ryan (1985), to the
extent to which the basic needs are satisfied, people will function effectively and develop in a healthy
way, but to the extent that they are thwarted, people will show evidence of illbeing and non-optimal
functioning.

Motivation, though often recognized as a single construct, is governed by a myriad of factors and
personal experiences. Ryan and Deci (2000) stated that people can be motivated because they value an
activity or because there is strong external coercion. They can be urged into action by an abiding
interest or by a bribe. They can behave from a sense of personal commitment to excel or from fear of
being observed. These situations contrast between cases of having internal motivation versus being
externally pressured by an individual or situation. Extrinsically motivated behaviors are those that are
performed to obtain rewards or outcomes that are separate from the behavior itself (Ryan, Frederick,
Lepes, Rubio, & Sheldon, 1997).

Self determination theory suggested that people experience more self-determined (or internally
controlled) types of motivation when the activities they participate in make them have competence (the
ability to effectively perform the behavior), relatedness (authentic social connections with others) and
autonomy (the power to make their own choices). More self-determined types of motivation are
desirable because they are associated with positive experiences and continued motivations to
participate (Deci & Ryan, 1985). In a study comparing exercise adherence in 40 university students
participating in either Tae Kwan Do or aerobic exercise, Ryan, et al., (1997) observed better adherence
in the Tae Kwan Do group. On further analysis, they attributed the better adherence to increased
enjoyment and competence motives in the Tae Kwan Do participants. In the exercise domain, exercise is
more extrinsically motivated as compared to sport. Most people maintain their exercise activities that
are not inherently interesting or enjoyable to them but have something to gain from it (Ryan, Williams,
Patrick, & Deci, 2009). A lack of intrinsic motivation to exercise activity leads to low adherence in a long
term perspective. In a recent meta analysis of the self determination continuum, Chatzisarantis,
Hagger, Biddle, Smith, & Wang (2003) found moderately strong correlations between more self-
determined forms of motivation and measures of intention and competence.

Socio-Ecological Theory

Ecological models of health behavior are models proposing that behavior is influenced by interpersonal,
sociocultural, policy, and physical-environmental factors (Sallis & Owen, 2002) The purpose of the

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ecological model is to primarily focus on the environmental causes of behavior and to identify
environmental interventions to promote health (McLeroy, Bibeau, Steckler, & Glanz, 1988). Ecological
theory has been extensively used to determine correlates of physical activity. Seasons are often
associated with physical activity and time spent outside is the best correlate of physical activity in young
children (Sallis & Owen, 2002). Irrespective of socio-economic status of people, those residing near the
coast reported higher levels of physical activity (Bauman, Smith, Stoker, Bellew, & Booth, 1999).
Proximity to physical activity programs is an important factor for both young individuals (Sallis,
Prochaska, & Taylor, 2000) as well as older adults (Booth, Owen, Bauman, Clavisi, & Leslie, 2000).
Convenient exercise facilities not only were strongly associated with physical activity but also strongly
predicted vigorous physical activity in men although these findings were not true in for case of women
(Sallis, Bauman, & Pratt, 1998). A cross sectional study by Hoehner, Brennan Ramirez, Elliott, Handy, &
Brownson (2005) in higher and lower income areas of St. Louis, MO (representing a low-walkable
city) and Savannah GA (representing a high-walkable city) showed associations between presence of
near-by recreational facilities and use of the facilities and also between use of the facilities and meeting
the recommendations through recreational activity. However, no direct association was present
between the presence of recreational facilities and meeting recommendations. These findings suggest
that individual-level factors and other environmental supports must be present before an individual
engages in the recommended level of recreational activity.

Increasing participation in regular physical activity has now become a national priority for many
industrialized nations. Interventions have the best effect when they alter and modify the underlying
correlates that influence physical activity. Exercise, like any other component of health care, is bounded
by physical, personal and environmental factors (Arcury et al. 2006). The failure to meet the Healthy
People 2000 recommendation are a result of the lack of understanding the underlying determinants that
govern an individual or societys participation in leisure time physical activity. In a recent review of the
correlates of adults participation in physical activity, Trost, Owen, Bauman, Sallis (2002) have concluded
that participation is influenced by a diverse range of personal, social and environmental factors. These
factors are referred to as determinants. Determinants denote a reproducible association or predictive
relationship other than cause and effect. Determinants that reside or originate within the individual are
included under personal factors. These include demographic correlates, biomedical status, past and
present physical activity performance, and psychological states and traits associated with physical
activity (Dishman 1988). In studies comparing men and women, physical activity patterns were higher
among males when compared to females and were also inversely associated with age (Trost, Owen,

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Bauman, Sallis 2002). Overweight and obesity also has a strong negative influence on physical activity.
Martinez-Gonzalez, Martinez, Hu, Gibney, and Kearney (1999) found that after controlling for age, time
spent sitting, sex, education, social class, marital status, smoking, country of origin, individuals in the
upper quintile for leisure time physical activity were approximately 50% less likely than those in the
lowest quintile to be classified as obese.

Psychological determinants of physical activity include enjoyment of physical activity, expected benefits,
value of physical activity outcomes, intentions, perceived behavioral control, normative beliefs,
knowledge of health and exercise, self efficacy, selfmotivation and stage of change. In a study examining
the influence of self-efficacy perceptions in a cohort of healthy adults between the ages of 50 and 64,
baseline self efficacy perceptions significantly predicted exercise adherence after 2 yr of follow up
(Oman and King 1998). In a population of elderly men and women, barriers to physical activity such as
lack of time, too weak, too tiring, fear of falling, bad weather and no exercise partners, emerged as the
greatest influence on leisure time activity (Lian, Gan, Pin, Wee, Ye 1999). The physical environment acts
as a determinant of physical activity. Accessibility to a facility, the appeal of the surrounding
environment, perceived threats and climatic conditions are the strongest predictors of physical activity
among environmental factors (Dishman 1988; Trost, Owen, Bauman, Sallis, Brown 2002). Access to a
facility is a necessary but not a sufficient facilitator of community sport and exercise participation.
Perceived convenience of the exercise setting and actual proximity to home or place of employment are
consistent discriminators between those who choose to enter or forgo involvement and between those
who adhere or dropout in supervised exercise programs (Dishman 1988). In one supervised exercise
program, those most likely to drop out actually lived closer to the chosen activity setting, although they
perceived inconvenience as a factor leading to their return to inactivity (Gettman, Pollock, Ward 1983).
A study involving Australians aged 60 yr and over, found that having friends who participated regularly
in physical activity, safe footpaths for walking, and having access to a park were significantly associated
with regular physical activity (Booth, Owen, Bauman, Clavish and Leslie 2000).

Correlates of Physical Activity in Rural Older Adults

People over 65 years of age constitute one of the fastest growing population segments among
industrialized nations. They also carry the greatest proportion of chronic disease burden, disability and
health care utilization (King, Rejeski, and Buchner 1998). PA has an important role in helping older adults

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preserve independence, control weight, and maintain muscle, joint and bone health (American College
of Sports Medicine, 1998). Although regular PA is critical for the promotion of health and function as
people age, people over 50 years of age represent the most sedentary segment of the adult population
(King, Rejeski, and Buchner 1998). This is particularly true for persons over 75 years of age.

Similar to their younger counterparts, participating in PA by older adults depends upon many different
factors. These factors change from individual to individual and from one society to another. However,
several studies suggest that rural older adults are consistently less active than their urban counterparts.
In a study comparing the physical activity patterns between rural and urban older adults in the various
regions of the US, the prevalence of physical inactivity was the highest in the most rural (33.1%) and the
2 least urban categories (range: 25.7% to 25.9%). The odds of being physically inactive were 43% higher
in the most rural compared with the most urban categories. In the South, prevalence of Physical
Inactivity was 43.1% in the most rural areas as compared to 26.7% in the most urban area. In contrast,
the prevalence of physical inactivity in the west was highest in the 2 urban categories (24.3% to 24.5%)
and lowest in areas categorized as most rural (19.7%). No association was found between physical
inactivity and degrees of urbanization in the Northeast or West (Matin et al. 2005). While age group and
gender are commonly assessed correlates of PA, not many studies have looked into other determinants
of physical activity among urban and rural older adults. In a recent study, age and education level was
found to negatively influence PA in rural older women. In the same study, higher perceived stress and
low self efficacy strongly decreased PA participation in rural older women while fewer depressive
symptoms and the perception of greater pros than cons remained independent predictors of higher PA.
On the whole, age was negatively associated with self-efficacy and social support (Wilcox et al. 2003).
However, this study specifically assessed women only.

QUALITY OF LIFE AND BARRIERS IN URBAN OUTDOOR ENVIRONMENT IN ELDERLY PEOPLE

Quality of life According to World Health Organization (1995) says that quality of life is defined as how
individuals perceive the position of their life in the context of the culture and value of the system in
which they live. Recent literature reviews on quality of life has described it as multidimensional
evaluation which includes domain such as health and symptoms, mood, functioning, life satisfaction and
participation. Rantakokko Merja et al. (2010) says that Lawton MP. (1973) found that one of the
influential conceptualization of quality of life is that of the multidimensional evaluation of human
behavior and well-being of the person environment system and of an individual time past, current and
anticipated. It is not yet widely studies but there is acknowledgment of the importance of environment

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for quality of life. Several studies have been limited to comparing the differences in quality of life
according to types of housing facilities, such as elderly institutions and in the elderly community
dwellings. These studies have shown lower quality of life scores for participants who are living in
assisted living facilities or nursing homes than for those who are living in the community dwellings.
Rantakokko Merja (2010) p.1

Levasseur Melanie et al. (2008) also says fougeyrollas P et al. (1998) found that participation and
environment can also be very important modifiable variables that can influ-ence community living and
targeted by health intervention among the elderly people. According to the World Health Organization
on the (International Classification of Function) it stated that activity level are one of the components of
the (ICF) shown in (figure1), that the environmental factors include the physical, social and attitudinal
environment in which the elderly people live and conduct their lives. Participating in activities is the
outcomes of interaction between the individual elderly health and contextual factors that include both
personal and environmental factors. Levasseur Melanie et al. (2008) p. 2

Quality of life measurement and models

Dimensions

Objective is the basis of observation and external to the individuals is seen as the standard of
living, income, education, and longevity and health status. Netuveli Gopalakrishnan et al. (2008)
says that, Erikson R. (1993) defined the objective dimension of quality as the individuals
command over resources in the form of money, possessions, knowledge, mental and physical
energy, social relations, security etc., in which the individual can control and consciously direct
their living conditions.
Subjective, is the psychological responses by the individual such as how they are satisfied with
life, happiness and self-ratings. Netuveli Gopalakrishnan et al. (2008) says that, World Health
Organization, quality of life group (1993) defined the subjective dimension of quality of life as
how individuals perceive their position in life through the context of culture and value system in
which they live and in relation to their targeted goals, expectations, standards and concerns.
This is a wide range concept in a complex way by which the individuals physical health,
psychological state, level of independence, social relationships and their individual relationship
to salient features of their environment.

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Domains

General physical health for example self-rated health or specific disease like asthma
Psychological aspect such as subject well-being, happiness, satisfaction of life
Social aspect such as social relationship and networks. Netuveli Gopalakrishnan et al. (2008)
says Testa MA, et al. (1996) found that in the context of medicine, a conceptual framework to
access the quality of life that combines the objective and dimensions and the three domains as a
third dimension had been suggested. Other research theory approaches the human needs and
their satisfaction and environmental well-being.

Instruments

Generic are used here to refer to the instrument which are common to all individuals whose
quality of life is been measured, as opposed to
The idiopathic that are tailored for individual participants.

THEORETICAL FRAMEWORK

The theoretical framework chosen for this thesis is the sense of coherence theory. According to
Antonovsky Aaron (1987) theory, it focuses on the argument called salutogenesis. This suggested that
we need to look at those who stay well despite being on high risk factors, for example. What is the
different about them? How are they able to cope? Why do some people cope better than others do?
What helps the person to cope? The Salutogenic orientation sees health as a continuum for example
(we are all terminal cases) and we are all, as far as there is a breath of life in us, in some measure
healthy. According Antonovsky theory of health on salutogenic, starts from the assumption that the
human and living systems are subject to unavoidable entropic processes (the damage and deterioration
caused by life and ageing), and unavoidable death. By reading the work of Antonovsky (1987) theory,
you will be able to find a metaphor of health that is based on the idea of a river. Contemporary western
medicine is likened to a wellorganized heroic, technologically sophisticated effort to pull drowning
people out of a raging river. But Antonovsky questions the accuracy of the metaphor and redefines the
river as the (stream of life). He also argued that no one walk the shore of river safely, so the nature of
ones river and things that shape ones ability to swim must all be considered. Therefore, the object is to
be able to study the river and find out what facilitate the capacity to joyfully swim for some, while for

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others to stay afloat is very difficult. So therefore we are in the dangerous river of life. The most
question that interest Antonovsky was why some of us are able to do better in the river of life? And why
people are able to survive despite being so high on risk factors?

Manageability

Antonovsky (1987) says a person with high SOC has the view that there was a high probability that
things will work out as well as can be reasonably expected. People have low SOC see themselves as the
ones that things always happen to. And this point of view is defined by Antonovsky as being linked to
the extent in which someone perceives that the resources at their disposal are adequate to meet the
demands posed by the life events that are bombarding them. Again this is not mere perception.
Peoples lives simply may not contain adequate resources given on the scale of what has to be managed.

Comprehensibility

This shows that a person who has a high SOC is able to see confronting events as making sense of what
they will expect. If the event is unexpected they will be ordered or explicable. This is not a matter that
an individual perception or delusion. Some peoples lives are neither ordered nor explicable due to the
social circumstances they live within

Conclusion

Exercise behavior is governed by a myriad of factors ranging from personal, or within ones thought
process, to the environment. The factors also differ to a great extent with different age groups. Given
the dearth of research assessing determinants in rural older adults, it is difficult to develop physical
activity interventions which are specifically tailored to this unique group. Research in the past has tried
to ascertain these factors using an underlying psychological theory. Not many studies have focused on
using all the theories at once. One such approach was carried out by Wilcox and coworkers (Wilcox,
Castro, King, Housemann, & Brownson, 2000) to determine key factors in rural and urban older adults
residing in South Carolina. A comparative study between rural and urban older adults by Parks,
Housemann, & Brownson (2003) found income as a significant predictor of PA with lower income
individuals reporting lower level of PA. Once these determinants have been identified, they can be used
to develop physical activity interventions which are focused specifically on removing the barriers and
promoting the incentives in this unique group. Hence the purpose of the current study is to determine

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the correlates of physical activity by incorporating the vital constructs from these behavioral theories
along with environment and other health related factors that have been shown to influence physical
activity in a Midwestern rural and urban setting.

CHAPTER 3.

METHODOLOGY

Participants and Procedure

150 survey questionnaires were distributed to older adults attending stroke detection clinics organized
at various locations within the state of Bedfordshire and Hertfordshire. The questionnaire included an
explanation of the purpose of the study and benefits to the participants. Participants were instructed to
place completed surveys in sealed envelopes.

Measures

Age, sex, level of education, county of residence, nearest town, distance from nearest town, marital
status, current perceived health status, perceived health status as of 5 years ago, and perceived health
barriers to doing things were obtained by self- report. These items as well as depressive symptom and
quality of life were tested as a socio-demographic variable.

Depression and Stress

The participants completed a five-item version of the Geriatric Depression Scale (Hoyl, et al., 1999). The
scores ranged from 0 to 5 (higher indicating greater depressive symptoms). The 5 items of the GDS has
been shown to have good sensitivity (.97) specificity (.85) positive predictive value (.97) and accuracy
(.90) for predicting depression and internal consistency ( = .80) (Hoyl, et al., 1999).

Satisfaction with life Sore

Life satisfaction refers to a cognitive judgmental process. Shin and Johnson (1978) defined life
satisfaction as a global assessment of a persons quality of life. The study included the Satisfaction
With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) which is a 5 item questionnaire rated on a

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seven point Likert scale. The score ranges from 5 to 35 and a higher score indicates greater satisfaction
with life. A study by Diener et al. (1985) on older adults indicated a inter rater reliability of 0.73.

Physical Activity

PA was measured using the Physical Activity for the Elderly (PASE) (Washburn, Smith, Jette, & Janney,
1993). The PASE is a brief instrument designed specifically to assess physical activity in older persons
over a 1-week time frame. Participation in leisure activities, including walking outside the home; light,
moderate, and strenuous sport, recreation activities and muscle strengthening were recorded as never,
seldom (12 days/wk), sometimes (34 days/week), and often (57 days/week). Duration of the
activities were categorized as less than 1 hour, between 1 and 2 hours, 24 hours, or more than 4 hours.
Paid or unpaid work, other than work that involves mostly sitting activity, was recorded in total hours
per week. Housework (light and heavy), lawn work/yard care, home repair, outdoor gardening, and
caring for others were recorded as yes/no (Washburn, McAuley, Katula, Mihalko, & Boileau, 1999). PASE
is a reliable and valid measure of PA in older adults (r = 0.75) (Washburn, et al., 1993). PASE has been
validated in older adults against two PA gold standards: doubly labeled water (r = 0.58) (Schuit,
Schouten, Westerterp, & Saris, 1997) and with portable accelerometry (r = 0.64) for those over the age
of 70 years; (Washburn, et al., 1999).

Perceived Physical Environment

The land-use mix diversity subscale of the Neighborhood Environment Walkability Scale (Saelens, Sallis,
Black, & Chen, 2003) was used as a measure to indicate proximity of various locations like grocery store,
post office, library and other such facilities to ones residence. The measure consisted of 23 questions
scored on a scale from 5 to 1 where 5 represented within 1 to 5 minutes walking distance, 4 indicated 6
to 10 minute walking distance and 3,2 and 1 indicating 11 to 20 minutes, 21 to 30 minutes and more
than 31 minutes walking distance respectively. A response of dont know or Not Applicable was
given 1 point. The subscale had a test retest reliability of 0.78. The Neighborhood Satisfaction subscale
of the Neighborhood Environment Walkability Scale (Saelens, et al., 2003) was used as a composite
measure to assess perceptions of environment quality. This measure consisted of 17 items scored on a
scale from 1 (strongly dissatisfied) to 5 (strongly satisfied). Example items include satisfaction with "how
easy and pleasant it is to walk in your neighborhood," and "access to shopping in your neighborhood.
The scores across all items were summed and divided by the number of items to arrive at a total scale

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score. Higher scores indicated greater levels of satisfaction with their neighborhood characteristics. This
subscale of the NEWS has a reliability of 0.80 (Saelens, et al., 2003).

Self Efficacy for Physical Activity

Self-Efficacy was measured with the Exercise Self-Efficacy Scale (EXSE) (McAuley, 1993). The 8 item scale
assesses the participants beliefs in their ability to continue exercising at a moderate intensity for 3
times per week for 40 minutes or more over the next 1 month. Participants rated their confidence
between 0% (Not at all confident) to 100% (highly confident). The mean score was calculated as physical
activity self efficacy. The construct validity of EXSE has been demonstrated in previous research by its
association with those social-cognitive factors theorized to be antecedents or consequences of self
efficacy (Bandura, 1997; McAuley, et al., 2007). These include exercise behavior (McAuley, et al., 2005),
social influences (McAuley, Jerome, Elavsky, Marquez, & Ramsey, 2003) and affect (McAuley, Jerome,
Marquez, Elavsky, & Blissmer, 2003).

Barrier Self Efficacy for Physical activity

The study measured barrier self efficacy using a 12-item barrier self-efficacy scale designed by McAuley
and Mihalko (1998) to assess adults perceived capabilities to exercise three times per week for next
three months in the face of barriers (e.g., bad weather, lack of interest/boredom, pain and discomfort).
Subjects rated their degree of confidence that they could exercise in the event that a barrier
circumstance were to occur on a 0% through 100% scale (0% = No confidence at all ;100 % = Highly
confident). Hausenblas, Nigg, Downs, Fleming & Connaughton (2002) reported an internal consistency of
0.88.

Attitude, Subjective Norm, Intention and Perceived Behavioral Control

The current study measured the various constructs of the Theory of Planned Behavior. The constructs
were measured using questions in a previous study on older adults by Gretebeck et al. (2007). Attitude
towards PA was measured using a 7-point semantic differential bipolar adjective scale (from -3 to 3). The
scale consisted of 8 adjective pairs. 5 of the 8 items measured the instrumental dimension and the
remaining 3 items were used to assess the affective aspect of attitude. Mean scores were calculated for
instrumental and affective attitude and more positive score indicated optimistic attitude. Cronbach
alpha for this scale was 0.94.

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A single item was used to quantify subjective norm. Participants rated their level of agreement with the
statement "Most people who are important to me think 1 should perform PA regularly." Subjective
norm was scored from 1 to 5 on a Likert type scale with a higher score representing greater influence by
others to perform PA. Perceived behavioral control was measured with 3 items. Subjects rated the ease
or difficulty and amount of control they had over performing PA for 30 minutes 3 days per week as well
as number of events that prevented PA performance on 5-point Likert-type scales. An average score was
calculated with higher scores representing greater perceived control over performing PA. Cronbach
alpha was reported at .70 (Gretebeck et al. 2007).

Intention was measured with 2 items. Subjects rated the likelihood of being physically active for 30
minutes 3 days/week. A second item asked if the participants intended to perform PA for 30
minutes/day for at least 3 days/week in the next 2 months. Items were scored from 1 to 5 on Likert-type
scales, and a mean score was calculated. A higher score reflected greater intention to participate in PA.
Cronbach alpha for the intention measure was high at .91 Gretebeck et al. (2007).

Physical Activity Decisional Balance (pros and cons of PA)

Participants completed a 16 item questionnaire on decisional balance, of which 10 items question were
pertaining to pros of PA while 6 items measured cons of PA (Marcus, Rakowski, & Rossi, 1992).
Participants rated how each item affected their decision or not to engage in regular physical activity. The
pros items were summed to produce raw scores that could range from 10 to 50. The cons items
were summed to produce raw scores that could range from 6 to 30. As instructed by Marcus, et al.
(1992) the pros and cons scales were converted to t scores so that they can be comparable. Good
internal consistency ( = .95) for pros and = .79 for cons) and validity (increased pros and decreased
cons with advancement in stage of exercise behavior) has been reported (Marcus, et al., 1992).

Social Support

Peer support for PA (from friends consisting of 15 items and from family consisting of 5 items) was
assessed using a 20 item questionnaire in which participants rate how often family and friends engaged
in acts that were supportive of PA in the past 3 months, from 1 (none) to 5 (very often) (Sallis,
Grossman, Pinski, Patterson, & Nader, 1987). As mentioned by Sallis, et al. (1987), family meant
member of the same household and friends were defined as friends, acquaintances or coworkers.

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Good test retest reliability (r = .57 to .86) has been documented (Sallis, et al., 1987). The mean of the
scores were calculated, higher score indicating greater social support.

Motives for Physical Activity

Motivation t for physical activity was assessed using the Motives for Physical Activity Measure - Revised
(MPAM-R) (Ryan et al. 1997). It is a questionnaire intended to assess the strength of five motives for
participating in physical activities. The five motives assessed were - Fitness, which refers to being
physically active out of the desire to be physically healthy and to be strong and energetic; Appearance,
which refers to being physically active in order to become more physically attractive, to have defined
muscles, to look better, and to achieve or maintain a desired weight; Competence/Challenge, which
refers to being physically active because of the desire just to improve at an activity, to meet a challenge,
and to acquire new skills; Social, which refers to being physically active in order to be with friends and
meet new people; and Enjoyment, which refers to being physically 21 active just because it is fun, makes
you happy, and is interesting, stimulating, and enjoyable (Ryan, et al., 1997).

Statistical Analysis

This study mainly focuses on correlates of PA in rural and urban older adults. Differences in the
correlates of PA between the two groups were examined by one way ANOVA. A correlational matrix was
constructed using Pearson correlational coefficients to determine the association between the various
correlates of PA behavior and PASE. A stepwise linear regression was conducted to determine the
constructs most associated with PASE in the rural, urban and both groups. Owing to the small sample
size, effect sizes were calculated for those correlates which were associated with PASE. Finally, the
components of each theory were regressed with PASE as the independent variable to determine the
association between each theoretical construct and physical activity in the two groups. A p < 0.05 was
considered statistically significant and p < 0.10 was considered as reflecting a statistical trend. Unless
indicated otherwise, all data are presented as mean SEM. Data were analyzed using SPSS for Windows
17.0.

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CHAPTER 5.

RESULTS

We distributed 150 surveys to rural and urban subjects who were attending a stroke detection clinic at
various locations across Bedfordshire and Hertfordshire. Of the 150, 41 surveys (55%) from rural locales
and 31 surveys (41%) from urban centers were returned.

Socio-demographic Characteristics

Table 1 provides the socio-demographic characteristics of the rural and urban subjects. Compared to the
urban subjects, rural older adults were significantly less educated and lived further away from the
nearest town or city. However, the rural group had higher Satisfaction with Life scores.

Comparison of Physical Activity and its Correlates

Table 2 is a Pearson correlation coefficient matrix of all the correlates of PA measured in this study. Not
surprisingly, components of each theoretical construct were correlated with each other. For example,
Perceived Behavioral Control was significantly correlated with Physical Activity Self Efficacy (r = 0.65)
and Physical Activity Self Efficacy was significantly associated with Barrier Self Efficacy ( r = 0.70). More
importantly, the measure of physical activity, PASE, was associated with Intention to Exercise (r = 0.46),
Barrier Self Efficacy (r = 0.42), Satisfaction With Life Scale (r = 0.36), Physical Activity Self Efficacy (r =
0.34), Perceived Behavioral Control (r = 0.28) and Instrumental Attitude (r = 0.20). Table 3 provides the
analysis of the correlates of physical activity by group. Effect sizes were also calculated for the correlates
of PA that were significantly different between the groups (i.e., either p < 0.05 or that showed a trend
towards significance at p < 0.10). The 23 two groups did not differ significantly in their reported physical
activity and were equally satisfied with their neighborhood. The urban subjects reported significantly
higher land-use mix diversity, physical activity self efficacy, social support from friends and competence
motivation for physical activity. Urban older adults also tended (p< 0.05), 21% (R2 = 0.21, p < 0.05), 17%
(R2 = 0.17, p < 0.05) and 6% (R2 = 0.06, p < 0.05) of the variance in PASE, respectively. None of the
Motives for PA entered the regression model in either the entire group, the urban group, or the rural
group.

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In the urban group, Socio-demographics and TPB explained 36% and 25% of the variance in PASE ,
respectively. Of all the socio-demographic correlates, Stand in the way of things and Education were
the only ones significantly associated with PASE. Intention was the only TPB construct predictive of PASE
in urban subjects. Land-use mix diversity, a component of the SocioEcological model, explained for 15%
(R2 = 0.15, p < 0.05) of the variance in PASE in the urban group. Physical activity self-efficacy, part of the
Social Cognitive Theory, explained 14% (R2 = 0.14, p < 0.05) of the variance in PASE. In the rural group,
socio-demographics and the Social Cognitive Theory equally explained 27% (R2 = 0.27 p < 0.05) of the
variance in PASE . Of all the socio-demographic correlates, Satisfaction with Life Score and Education
were the only ones associated with PASE. Barrier Self Efficacy, a component of the Social Cognitive
theory, explained 27% of the variance in PASE . Similar to the urban group, Intention was the only TPB
construct that entered into the model (R2 = 0.18 p < 0.05).

Table 1 Socio-demographic characteristics of rural and urban individuals

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Table 2 Correlation Coefficients of the various correlates of PA with both groups considered together

Table 3 Differences in Physical activity score (PASE) and PA correlates in rural and urban subjects

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Table 4 Association of PASE with individual theories of PA behavior

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Chapter 5.

DISCUSSION

Study Compared to Previous Literature

Lack of participation in physical activity can be linked to a myriad of social, psychological and health
reasons. In the past, several studies (Brownson, et al., 2000; Trost, Owen, Bauman, Sallis, & Brown,
2002; Wilcox, et al., 2003) have assessed correlates of PA in rural populations. However, relatively few
studies have compared these correlates with otherwise similar urban groups. Moreover, most of these
previous studies have had a relatively narrow focus, primarily assessing socio-demographic correlates of
PA such as age, education, income levels, gender and race. The extent to which rural older adults and
urban older adults differ in their attitudes towards PA remain uncertain. Thus, the main purpose of the
present study was to assess a wide range of correlates of PA, including sociodemographic, psychological,
and environmental correlates of physical activity in older adults residing in urban and rural Bedfordshire
and Hertfordshire. For the entire cohort of older adults assessed here, PA, assessed by PASE, was
significantly associated with Intention to Exercise (r = 0.46), Barrier Self Efficacy (r = 0.42), Satisfaction
With Life Scale (r = 0.36), Physical Activity Self Efficacy (r = 0.34), Perceived Behavioral Control (r = 0.28)
and Instrumental Attitude (r = 0.20). However, there were differences among the rural and urban groups
which will be discussed below.

18BSocio-demographic Correlates In this study physical activity was assessed using the PASE scale. There
was not a significant difference in reported PA levels between the urban and rural subjects. This 30
finding is at odds with previous literature (Brownson, et al., 2000; Parks et al., 2003). One reason for this
disparate finding may be that the current study did not quantify PA nor was PA reported in terms of the
Surgeon Generals physical activity recommendations. Second, the rural counties assessed here had
agriculture as the primary occupation, so these adults may have been more active. Third, unlike previous
studies which had a diverse sample population and reported African Americans to have low levels of PA,
all subjects in this were Caucasian. In addition, both sexes were equally represented in the present
study. Previous relevant research included primarily women (Brownson, et al., 2000; Wilcox, et al.,
2000) . Finally, most of the subjects (74%) reported good to excellent current health status. This may
have contributed to the lack of difference in physical activity levels amongst the two groups.

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Consistent with other studies comparing rural and urban groups, education was significantly different
between the two groups. However, it was only associated with the behavior of PA in urban subjects. In
contrast to previous literature (Duelberg, 1992; Macera, Croft, Brown, Ferguson, & Lane, 1995), this
study did not find a significant association between any socio-demographic measures and PA when the
groups were considered together.

Environmental Correlates

Not surprisingly, there were significant differences in the environmental correlates between rural and
urban subjects. Land use mix diversity (i.e., indicative of places one can approach by foot easily) and
distance from the nearest town were significantly different among the two groups. Land use mix
diversity alone was associated with PA behavior in the urban group but this association was relatively
weak ((R2 = 0.15). In general, , urban environments offer higher landuse diversity and more access to
places that promote PA behavior. For example, the rural group generally did not have any access to
sidewalks in their neighborhoods while the urban group did. On the other hand, both groups were
relatively satisfied with their neighborhoods with rural subjects being slightly more satisfied. This may
be explained by the finding that 78% of the subjects in both the groups reported little to no limitation to
PA. People with little to no limitations tend to report greater neighborhood satisfaction (Morris,
McAuley and Motl, 2008)

Psychological, Social and Behavioral Correlates

This study assessed psychological and behavioral correlates based on the constructs of Theory of
Planned Behavior (Ajzen, 1988), Social Cognitive Theory (Bandura, 1986, 1997) and Self Determination
Theory (Ryan & Deci, 2000; Ryan, et al., 1997). There were significantly higher instrumental and affective
attitudes in rural subjects than the urban group. Unlike previous literature (Brenes, Strube, & Storandt,
1998; Trost, et al., 2002), but similar to a study by Michels and Kugler (1998), intention was the only TPB
construct that was significantly associated with PA behavior, or PASE. This was true for urban subjects as
well as when both the groups were considered together. Brenes et al. (1998) did not take duration of
exercise into consideration and also measured intention over a 3 month period unlike the 20 minute and
2 month periods used in the present study. Older adults often cannot exercise for prolonged periods and
also find it difficult to judge their intention over a long period of time. This could have resulted in the
observed difference in this study. However, none of the other constructs of the TPB, namely normative

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factor, perceived behavioral control and attitude, explained a significant proportion of the variance in
PASE.

Barrier and Physical Activity Self Efficacy was assessed in this study. It was hypothesized that rural
subjects would have lower Barrier and PA Self Efficacy than the urban group and higher levels would be
associated with PA. Contrary to this hypothesis, both rural and urban subjects did not differ in Barrier
Self Efficacy; although it explained the largest amount of variance of PASE in the rural older adults (R2 =
0.27). We speculate that higher Barrier Self Efficacy in the rural group may have offset the reduced Land
Use Mix Divesity and, in so doing, contributed to greater levels of physical activity. Physical Activity Self
Efficacy was significantly lower in the rural subjects compared to urban counterparts; however, contrary
to our hypothesis and previous literature (Booth, et al., 2000; King, et al., 2000), it was not associated
with physical activity in either rural or urban subjects. This finding may be a result of the relatively small
sample size and the age range of our study. Another factor which may have influenced this finding was
how PA was defined or phrased in the questionnaires. Although all the questionnaires we used had been
previously found to be valid and reliable, subtle differences in how PA was defined may have affected
subject responses. For example, the Barrier Self Efficacy Questionnaire (McAuley et al. 1998) defined
Physical Activity as Exercise while the Intensity questionnaire (Gretebeck et al. 2007) phrased
Physical Activity as Physical Activity. Rural subjects may not have viewed some of their daily
activities (e.g., the physical demands of farming) as exercise or PA per se and so their responses may
have been skewed.

Intrinsic motivation for physical activity in older adults has not received much attention in the literature.
The present study is unique in that intrinsic motivation for physical activity was assessed under five
domains Interest/Enjoyment, Competence, Appearance, Fitness and Social. Rural subjects recorded
lower levels of motivation in all domains 33 compared to urban counterparts; competence attained
statistical significance, while appearance and fitness tended to be lower (p <0.10).

Regardless, none of the motivational domains explained any of the variance in PA in either of the
groups. Considerable research suggests that social support is as an important predictor of physical
activity in both urban and rural populations (Booth, et al., 2000; King, Castro, et al., 2000; Parks, et al.,
2003; Wilcox, et al., 2000). Social support for PA was assessed under 2 categories Family support and
Friends support. Surprisingly, social support was not associated with PA behavior in either group,
although social support through friends was significantly higher in the urban subjects.

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Previous research suggests that depression and satisfaction with life can affect PA. The rural subjects
reported significantly higher satisfaction with life which was contrary to our hypothesis. Our review of
literature did not locate any studies comparing life satisfaction among rural and urban residents,
although studies have reported significantly higher Satisfaction With Life in more active people
(McAuley, et al., 2000; Rejeski & Mihalko, 2001). As supported by Wilcox et al. lower depressive scores
were significantly associated with higher PASE scores in rural older adults. The factors explaining the
most variance in PA in rural subjects in this study, namely Barrier Self Efficacy, depression, and pros and
cons towards PA, are similar to the findings by Horne (1994) on rural older homemakers.

Implications for Interventions to Promote PA

Contrary to previous thinking, locale (i.e residing in urban or rural environment) was not strongly
associated with PA (Table 4). Environment explained only 15% of the variance in PASE in the urban
group and did not enter the model in the rural group. The mean General Neighborhood Satisfaction
Scale in this study was high. Thus, when subjects are generally satisfied with the neighborhood it does
not appear to influence PA performance. Irrespective of the group, none of the five domains of Motives
for Physical Activity were associated with PASE. As noted from the correlational matrix (Table 2),
Motives for Physical Activity were significantly associated with most other constructs assessed. Owing to
this inter-variability, the variance explained by Motives for Physical Activity was likely subsumed by
other PA correlates and did not enter the model.

Socio-demographics and TPB were most associated with PASE in the urban subjects. Of all the socio-
demographic correlates, Stand in the way of things was most associated with PASE. Thus, physical
limitations are a significant barrier to PA behavior in older adults. Intention to exercise was the only TPB
construct that was significantly associated with PASE. Hence, when prescribing exercise to urban
subjects, one must take their physical or health-related shortcomings into consideration. Conducting
group sessions and community based programs would enhance ones intention to perform regular PA.
Watching peers exercise (i.e., modeling) and performing supervised exercise program in the community
(i.e., vicarious experiences) would likely increase Physical Activity Self Efficacy. The latter explained 14%
of the variance in PASE in the present study.

In the rural subjects, a significant finding in this study was that the socio-ecological theory constructs
were not associated with PASE. Barrier Self Efficacy, or the confidence a person has in overcoming
barriers and perform PA, accounted for 27% of the variance in PASE. When promoting exercise in a rural

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environment, one must therefore take into account the barriers faced by the subjects. Addressing ways
to overcome the barriers would likely increase PA participation and maintenance of exercise behavior.
35 In both groups, Intention to Exercise was the only TPB construct that was significantly associated with
PA behavior. An individuals intention towards short and long term adherence to PA must be considered
when prescribing exercise to both these groups of unique adults. The PASE scores seen in the present
study were similar to those found in rural older adults by Wilcox et al. (2003). Wilcox et al. (2003) found
PASE to be significantly associated with Self Efficacy similar to this study. This study extends the one by
Wilcox et al. (2003) by measuring Barrier Self Efficacy and the various Theory of Planned Behavior
constructs and their association with PASE. According to Azjen and Fisbein (1975), if a person intends to
do a behavior then it is likely that he will do it. Intention is guided by attitude towards the behavior as
well as subjective norms, or a combination of perceived expectations from relevant individual or groups.
Hence, promoting factors that would change an individuals attitude towards exercise like education
sessions, explaining benefits, conducting fun-filled group play activities for older adults would enhance
or positively impact attitude. Watching their significant others or peers perform PA would positively
change ones intention to perform PA.

Limitations

There are several limitations to our study. All data were collected through mail out surveys. This not only
resulted in a small sample size but the subjects were unable to clarify any questions that arose while
answering the questions. In this study, many of the correlates might have been predictors of PA if we
had a larger sample size. Secondly, the current study did not quantify physical activity using
accelerometers or other such devices and relied on the self report PASE score. PASE measures PA over a
week and is subject to recall bias while accelerometer is a more accurate measurement of PA. This study
did not restrict physical activity to just Leisure Time Physical Activity (LPTA) but included their
occupation and caring for others as well. Lastly, in our effort to assess all the psychological constructs
thoroughly the sheer volume of the survey could have resulted in a boredom factor impacting some of
the answers.

In conclusion, apart from environmental factors/barriers, there exist significant difference in

psychological, social, emotional and behavioral factors in rural and urban adults. Intention to exercise
was the most significant predictor when both populations were considered together. Barrier Self
Efficacy, depression and greater pros and cons remained significant predictors in rural older adults.
Intention and education were predictors in urban adults. Any physical activity program targeting these

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two unique groups must be tailor made and focused on modifying these correlates to make it effective
in the long term.

References

Appendix

Questionnaire Survey

Academic Research Study on Elderly Citizens and their Sports/Physical Activity Habits in the UK

1. In the past week, on how many occasions have you walked constantly, at least for 10 minutes
for leisure, workout or to get from and to places?
2. What was the estimated total time which you spent walking like this in last week?
3. In the past week, how many times did you do any energetic gardening or substantial work in
courtyard or lawn, which made you to breathe firmer puff and pant?
4. What according to you would be the total estimated time doing such forceful work, in the last
week?

For the next 4 questions (exclude physical activities such as doing the household work, gardening or
lawn work)

5. How many times did you do any forceful physical commotion which made you breathe harder or
puff and pant (for instance - outdoor games, riding a cycle, running, aerobics or other physical
activity)?
6. What would be the approximation of the total time spent on doing forceful physical activity in
the last week?
7. How many times in the last week did you do any other restrained physical activity which you
have not already stated (e.g. swimming, cricket, tennis, golf, etc)?
8. In the last week, what was likely the total time spent doing these physical activities?

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For questions 9 15 answer as in how many hours or times you have conducted the activity in the last
week

Sl Question No of Times No of Hours per session (Likert

Scale)
9 Visit with friends or family How many Less 1-2 2-3 3-4 4-6
(other than those you live TOTAL hours a than hours hours hours hours
with)? week did you 1
usually do it? hour
10 Participate in church and
religious activities to take
part in the community
functions?

11 Participate in club or group

meetings?

12 Play a musical instrument?

13 Work on your car, truck,

lawn mower, or other
machinery?

14 Walk uphill or climb uphill?

15 Walk fast or quickly for

workout?

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