Palacios-Ceña et al.

BMC Public Health 2011, 11:799

http://www.biomedcentral.com/1471-2458/11/799

RESEARCH ARTICLE Open Access

Time trends in leisure time physical activity and

physical fitness in elderly people: 20 year follow-
up of the Spanish population national health
survey (1987-2006)
Domingo Palacios-Ceña1,3*, Cristina Alonso-Blanco1, Rodrigo Jiménez-Garcia2, Valentin Hernández-Barrera2,
Pilar Carrasco-Garrido2, Elena Pileño-Martinez1 and Cesar Fernández-de-las-Peñas4

Abstract
Background: To estimate trends in leisure time physical activity and physical fitness between 1987-2006 in older
Spanish people.
Methods: We analyzed data collected from the Spanish National Health Surveys conducted in 1987 (n = 29,647),
1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The number
of subjects aged ≥ 65 years included in the current study was 29,263 (1987: n = 4,958-16.7%; 1993: n = 3,751-
17.8%; 1995-97: n = 2,229-17.4%; 2001: n = 4,356-20.7%; 2003: 6,134-28.3%; 2006: 7,835-26.5%). Main variables
included leisure-time physical activity and physical fitness. We analyzed socio-demographic characteristics, self-rated
health status, lifestyle habit and co-morbid conditions using multivariate logistic regression models.
Results: Women exhibited lower prevalence of leisure time physical activity and physical fitness compared to men
(P < 0.05). The multivariate analysis for time trends found that practising leisure time physical activity increased
from 1987 to 2006 (P < 0.001). Variables associated with a lower likelihood of practicing leisure time physical
activity were: age ≥ 80 years old, ≥ 2 co-morbid chronic conditions, and obesity. Variables associated with lower
physical fitness included: age ≥ 80 years, worse self rated health; ≥ 2 medications (only for walking), and obesity.
Conclusions: We found an increase in leisure time physical activity in the older Spanish population. Older age,
married status, co-morbid conditions, obesity, and worse self-perceived health status were associated with lower
activity. Identification of these factors can help to identify individuals at risk for physical inactivity.

Background suggests that PA is associated with more years of life,

In recent years, there has been an increase of aging in self-perceived healthy life, years without impairment in
the society [1]. The aging of the population can lead to daily live activities [6], lower rates of functional decline
an increase in the number of individuals at risk for [7], lower risk of mortality [8,9], increased longevity
chronic diseases [2]. In an article from the Center for [6,10], reduced risk of type 2 diabetes [11], and better
Disease Control and Prevention’s Healthy Aging Net- quality of life [12].
work, physical activity (PA) was considered one key ele- Physical activity is defined as any bodily movement
ment for determining health status [3]. Recent produced by skeletal muscles that result in energy
guidelines include PA recommendations for older peo- expenditure [13]. Nevertheless, physical activity is a
ple [4] because regular PA can provide health benefits, broad term that encompasses both leisure-time activity
even when it is initiated later in life [5]. In fact, evidence (sports, exercise) [13] and activities of daily life [13,14].
Leisure time physical activity (LTPA) refers to condi-
* Correspondence: domingo.palacios@urjc.es tioning exercise or sports not related to regular work
1
Department of Health Science II, Universidad Rey Juan Carlos, Madrid, Spain activities [13,15]. Walking is the most common form of
Full list of author information is available at the end of the article

© 2011 Palacios-Ceña et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
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reproduction in any medium, provided the original work is properly cited.
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physical activity and is recommended for all ages The Spanish National Health Surveys (SNHS)
[16-18]. Physical fitness is defined as a set of attributes We conducted a cross-sectional study using individua-
that people have or achieve that relates to the ability to lized data obtained from the SNHS done in 1987, 1993,
perform physical activity [13]. In fact, different studies 1995, 1997, 2001, 2003, and 2006. The SNHS is an
have used walking and walking up-stairs to evaluate ongoing, home-based personal interview examining a
physical fitness of older people [19,20]. However, PA national representative sample of non-institutionalized
research has mainly focused on middle-aged and the population residing in main family dwellings (house-
elderly combined [17,21-28]. In fact, few studies have holds) of Spain and is mainly performed by the Ministry
investigated PA only in older people [14,16,29-33]. of Health and Consumer Affairs and the National Statis-
Studies conducted in the USA [28], Australia [21], tics Institute (Instituto Nacional Estadística-INE). The
England [27] and Scotland [22] had reported a trend SNHS uses a multistage cluster sampling, with propor-
towards an increased PA in individuals older than 60 tional random selection of primary and secondary sam-
years of age. In fact, the increase in PA has been found pling units (towns and sections, respectively), with the
to be higher in people older than 65 years than in mid- final units (individuals) being selected by means of ran-
dle-aged population [17,25,33]. Nevertheless, some dom routes and sex- and age-based quotas.
authors have suggested the opposite, that older people Surveyors were previously trained about basic commu-
report lower PA [21,23,26]. In line with this hypothesis, nication skills, procedures and the used questionnaire.
the Center for Disease Control [24] reported that the Informed consent was signed by all participants before
prevalence of LTPA declined from 29.8% in 1994 to they answered the survey. In order to meet the surveys’
23.7% in 2007 in the United States. stated aim of being able to furnish estimates with a cer-
In Spain, more than 40% of older adults are sedentary tain degree of reliability at both national and regional
[34-37]. Although the percentage of people who practice levels the following samples of adult aged 15 years and
LTPA has increased [36], more information is needed to older were selected in the SNHS: 29,647 in 1987; 20,707
understand factors that facilitate or inhibit older people in 1993; 21,058 in 2001; 21,650 in 2003; and 29,478 in
tendency to engage in LTPA. Previous studies con- 2006. Surveys conducted in 1995 and 1997 were based
ducted in older adults have reported that important on smaller sample sizes (N = 6,400), therefore these two
variables for PA include those potentially handled from databases were joined and analyzed together. The num-
public health and social-educational policies: gender ber of subjects aged ≥ 65 years included in the study
[16,29,33], age [16,22,29], educational level [14,32,33], along the entire period was 29,263 (1987: n = 4,958-
monetary income [14,17,32], marital status [29], co-mor- 16.7%; 1993: n = 3,751-17.8%; 1995-97: n = 2,229-17.4%;
bid diseases [16,17,29], alcohol consumption [16,17], 2001: n = 4,356-20.7%; 2003: 6,134-28.3%; 2006: 7,835-
smoking [17,29], self-perceive health [30,33], and obesity 26.5%). More details about the SNHS methodology are
[14,22,31]. described elsewhere [38,39].
No previous study has examined the time trends of For the purpose of the current study, we included
physical activity in the last 20 years in older Spanish answers from adults aged 65 years and older from these
people. Therefore, the current study examines time 7 SNHS. The variables included in the current study
trends in prevalence of PA for adults aged 65 and over were created on the basis of several questions included
using Spanish National Health Surveys (SNHS) con- in the questionnaires and identical in all surveys. The
ducted in the period 1987-2006. The objectives of this dependent variables were: 1, LTPA, which was collected
study were: 1) to describe the prevalence of LTPA and using the following question: “Do you practice any phy-
physical fitness among the Spanish elderly population in sical activity during your leisure time?”, with 2 possible
the period 1987-2006; 2) to determine socio-demo- answers: “none” or “once a month or more”, and 2, phy-
graphic features, self-perceived health status, co-morbid- sical daily fitness, which was assessed with 2 questions:
ity, and lifestyle-related habits associated with LTPA “Can you walk up 10 steps without help?” and, “Can
and physical fitness in older people; and, 3) to analyze you keep walking for one hour without rest?.” The
time trends in prevalence of LTPA and physical fitness answer to both questions could be “yes” or “no”. These
in the period 1987-2006 in Spanish older people. last two questions were first collected within the 1993
survey.
Methods We also analyzed socio-demographic characteristics
Ethical aspects such as age (65 to 79 years, 80 years and older), marital
As this analysis was conducted on a de-identified, pub- status (married or living as a couple, unmarried/widow/
lic-use dataset it was not necessary to have the approval divorced), and educational level (no study, primary edu-
of an ethics committee according to Spanish legislation. cation completed, secondary education, or more).
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Self-perceived health status was assessed with the fol- but significantly older than men in all surveys (P < 0.05).
lowing question: “How did you self-perceive your health Tables 1, 2 summarize the distribution by socio-demo-
status over the previous 12 months?” Subjects described graphic characteristics and health related variables
their health status as very good, good, fair, poor, very among women and men according to the SNHS con-
poor. The answer was dichotomized into very good/ ducted (1987 2006).
good or fair/poor/very poor self-perceived health status. Among women, the prevalence of those married,
We also collected the number of medical doctor diag- higher education, higher number of chronic conditions
noses of co-morbid chronic conditions (high blood pres- and medications, obesity and smoking habit significantly
sure, diabetes, chronic heart disease, chronic bronchitis, increased along the period 1987-2006 (P < 0.01). Among
emphysema, or asthma) as follows: none, one, two, or men, the evolution was very similar to women except
more. The number of prescribed medications for any of for smoking habits that decreased from 33.8% to 15.4%
these chronic conditions was also categorized as none, (P < 0.01).
one, two or more. Body mass index (BMI) was calcu- Time trends for LTPA, capacity to walk up ten steps
lated from self-reported body weight and height. Indivi- without help and to walk for one hour without rest by
duals with a BMI ≥ 30 were classified as obese, those aged-group and gender are summarized in Table 3.
with BMI between 25 and 29.9 were classified as over- Overall, women exhibited lower prevalence of LTPA
weight and those with BMI < 25 were considered to and physical fitness (in both variables) as compared to
have normal weight. Individuals with BMI < 18.5 or men in all surveys (P < 0.01). In both gender, the preva-
incomplete data on height and weight were excluded for lence for all dependent variables were always higher in
the analysis. the younger aged group. The highest prevalence of
Regarding lifestyle habits, smoking habits differen- LTPA was found for both genders in the SNHS con-
tiated between current smokers, non-smokers or ex- ducted in 2006, with 54.6% for women, and 69.6% for
smokers. Finally, sleep habits were divided into subjects men, respectively (P < 0.05).
sleeping > 8 hours per day and those sleeping < 8 hours Crude time trends analysis by aged-group and gender
per day. revealed an increase in the prevalence of LTPA over
time among women and men in all aged-groups (P <
Statistical analysis 0.001). On the contrary, no significant changes for phy-
In this study we analyzed physical activity and physical sical fitness during the time period by gender or aged-
fitness separately for men and women and we excluded group were found (P > 0.05).
respondents with missing data for any outcome. We cal- The multivariate analysis for time trends in women
culated descriptive measures for all variables of interest found that LTPA increased significantly from 1987 to
by aged-group and SNHS. Second, we compared the 2006 (P < 0.001, Figure 1). In addition, time trends
reported prevalence for the dependent variables and age (1993-2006) for the variable walking for one hour, but
group according to the SNHS. Third, we fit logistic not for walking 10 steps without help (Figure 2) also
regression models by gender to assess factors indepen- exhibited a significant improvement (P < 0.01, Figure 3).
dently associated for each dependent variable. Finally, to The results of the multivariate analysis to estimate time
evaluate the time trend across the period 1987-2006, trends and associated factors for older women are sum-
adjusted odds ratios (ORs) with their confidence inter- marized in the table 4. Further, variables significantly
vals were estimated using multivariate logistic regression associated with a lower likelihood of reporting LTPA
models. Models were initially adjusted by age and by among women were: age ≥ 80 years, ≥ 2 co-morbid
those variables that yield significant associations within chronic conditions, and obesity. Variables associated
the bivariate analysis. We assessed significant interaction with not being able to walk up ten steps or walking for
terms in fully adjusted models; for significant effects, we one hour included: age ≥ 80 years, worse self-rated
stratified the fully adjusted models by the relevant fac- health, ≥ 2 medications (only for walking for one hour)
tor. The estimates were made using the “svy” (survey and again obesity.
command) functions of the STATA program, which Among men, LTPA has also significantly increased
allowed us to incorporate the study design and weights from 1987 to 2006 (P < 0.001, Figure 1), but no signifi-
in all our statistical calculations. Statistical significance cant changes for physical fitness were observed (Figures
was established at P < 0.05 (two-tailed P values). 2, 3). The results of the multivariate analysis to estimate
time trends and associated factors for older men are
Results found within table 5. Factors associated to less practi-
The mean age increased significantly from 72.3 to 74.8 cing LTPA in men were: age ≥ 80 years, being married,
years for women and from 72.2 to 74.5 years for men and obesity. Variables associated with worse physical fit-
across the study period (P < 0.05). Women were slightly, ness among men were the same as for women: age 80
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Table 1 Frequencies Statistic for WOMEN: Spanish National Health Surveys (SNHS) 1987, 1993, 1995-7, 2001, 2003 and
2006
SNHS 1987 SNHS 1993 SNHS 95-97 SNHS 2001 SNHS 2003 SNHS 2006
N = 2,846 N = 2,137 N = 1,303 N = 2,494 N = 3,830 N = 5,022
Age Mean (SE)+ 72.3 (0.15) 74.3 (0.23) 72.6 (0.17) 73.0 (0.14) 74.7 (0.16) 74.8 (0.14)
Age group+ 65-79 85.5 84.5 84.9 83.6 76.2 75.5
≥ 80 14.5 15.5 15.1 16.4 23.8 24.5
Marital status* Unmarried/widow/divorced 54.0 47.9 49.8 47.5 50.9 49.4
Married or living with couple 46.0 52.1 50.2 52.5 49.1 50.6
Educational level* No studies 72.9 49.7 38.9 26.5 42.0 42.0
Primary education completed 21.7 42.7 55.2 67.2 46.3 45.2
Secondary education or more 5.4 7.6 5.9 6.3 11.7 12.8
Self rated health Very good/good 34.6 39.4 37.0 36.5 33.0 33.1
Fair/poor/very poor 65.4 60.6 63.0 63.5 67.0 66.9
Nª of chronic conditions* None 40.8 41.3 37.6 32.9 26.8 19.0
1 31.8 33.0 32.3 33.2 33.2 32.7
≥2 27.4 25.7 30.1 33.9 40.0 48.3
Number of medications* None 26.7 26.1 19.0 15.4 9.1 6.5
1 34.5 33.6 33.1 31.2 21.4 14.7
≥2 38.8 40.3 47.9 53.4 69.5 78.8
BMI* Normal 41.6 39.1 49.7 31.2 35.2 31.5
Overweight 41.9 43.4 31.4 41.8 42.3 42.4
Obesity 16.5 17.5 18.9 27.0 22.5 26.1
Smoking habits* Smoker 1.9 3.9 1.7 2.2 1.7 3.1
Ex Smoker 2.7 2.5 2.4 2.9 2.9 4.5
Non Smoker 95.4 93.6 95.9 94.9 95.4 92.4
Sleep habits (hours day) <8 45.8 48.2 41.9 42.8 44.8 46.8
≥8 54.2 51.8 58.1 57.2 55.2 53.2
Data are expressed as percentages (%)
+
Significant differences between SNHS/*Significant differences between SNHS (adjusted by age)

years or over, worse self-rated health, ≥ 2 medications, the Health Survey in England (1991-2004) found an
and obesity (only for walking for one hour). upward trend in regular sports participation in all age
groups, but particularly pronounced among the older
Discussion groups (≥ 65 years) [27]. The Behavioral Risk Factors
Our study revealed an increase in LTPA from 1987 to Surveillance System found an increase in the prevalence
2006 in older Spanish people. The results are consistent of walking from 1987 to 2000, particularly in older peo-
with studies conducted in European, American and ple [28]. The Japan Collaborative Cohort Study also
Asian countries [22,25,27]. In Spain, the study con- showed an increase in sports and physical exercise in
ducted by Roman-Viñas et al [40] observed a slight subjects aged 50-79 years old [25]. Previous studies have
decreased in the proportion of sedentary leisure time shown a tendency that decreased activity occurs with
activities for males (from 50% to 45%) and females increasing age [14,24,31]; however, a cross-sectional
(from 67% to 63%). However, this study was conducted study conducted with Chinese women found that older
in Catalonia, a region of Spain, and did not focus in age was positively associated with participation in exer-
LTPA in older people [40,41]. Therefore, our study is cise/sports and walking [17].
the first one that includes national data over a period of We have also found that women exhibit lower preva-
20 years in the Spanish older population. lence of LTPA and physical fitness as compared to men
The Scottish Health Survey found an increase in PA in all surveys, which is in agreement with the results by
among older people aged between 65 to 74 years, but a Stamatakis et al [27]. The Cardiovascular Health Study
decline in walking (65-74 year) and training sports showed that men were more active in LTPA than
among 75 years and over [22]. The results derived from women in all age groups [6], which also agree with the
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Table 2 Frequencies Statistic for MEN: Spanish National Health Surveys (SNHS) 1987, 1993, 1995-7, 2001, 2003 and
2006
SNHS 1987 SNHS 1993 SNHS 95-97 SNHS 2001 SNHS 2003 SNHS 2006
N = 2,112 N = 1,614 N = 926 N = 1,862 N = 2,304 N = 2,813
Age Mean (SE)+ 72.2 (0.18) 74.9 (0.28) 73.3 (0.21) 73.3 (0.16) 73.8 (0.19) 74.5 (0.16)
Age group+ 65-79 85.3 84.7 84.6 84.4 80.5 77.3
≥ 80 14.7 15.3 15.4 15.6 19.5 22.7
Marital status Unmarried/widow/divorced 20.8 22.7 20.2 19.4 19.0 20.0
Married or living with couple 79.2 77.3 79.8 80.6 81.0 80.0
Educational level* No studies 57.9 32.3 34.7 21.2 34.8 30.4
Primary education completed 29.7 49.9 52.6 66.3 44.5 45.5
Secondary education or more 12.4 17.8 12.7 12.5 20.7 24.1
Self rated health* Very good/good 45.0 48.4 44.5 47.6 44.9 48.5
Fair/poor/very poor 55.0 51.6 55.5 52.4 55.1 51.5
Nª of chronic conditions* None 44.5 47.4 40.9 35.6 33.0 21.6
1 32.3 34.2 33.9 33.7 33.5 32.3
≥2 23.2 18.4 25.2 30.7 33.5 46.1
Number of medications* None 37.7 36.4 26.3 22.1 15.0 12.3
1 35.0 37.7 37.0 34.1 30.6 22.8
≥2 27.3 25.9 36.7 43.8 54.4 64.9
BMI* Normal 45.1 37.8 40.3 30.9 27.7 28.0
Overweight 44.5 48.1 45.1 51.8 53.1 51.0
Obesity 10.4 14.1 14.6 17.3 19.2 21.0
Smoking habits* Smoker 33.8 27.9 24.2 19.3 16.8 15.4
Ex Smoker 43.3 43.9 50.0 53.1 52.2 54.3
Non Smoker 22.9 28.2 25.8 27.6 31.0 30.3
Sleep habits (hours/day) <8 59.5 57.3 56.8 52.3 61.0 58.0
≥8 40.5 42.7 43.2 47.7 39.0 42.0
Data are expressed as percentages (%)
+
Significant differences between SNHS/*Significant differences between SNHS (adjusted by age)

current results. Contrary, Simpson et al. [28] have with a lower likelihood of reporting LTPA in both gen-
shown a higher prevalence of elder women who walk. In ders, which is in agreement with previous studies con-
this study, women were two to three times more likely ducted in Australia [16] and USA [29]. Gallant and
than men to report that walking was one of their LTPA. Dorn [42] reported that marital status showed an influ-
The decreased prevalence of LTPA among women can ential element in men’s health behavior. Our results are
be attributed to monitorization of daily transports [26]. also consistent with Kaplan et al [29] who found that
Gallant and Dorn [42] have reported that social network married subjects were less likely to be active than single,
emerged more importantly for women than for men, widowed, or divorced.
which indicates that women may perform many of The current study also found that education level (pri-
health behaviors within a social context [43]. The omis- mary or over) was related with LTPA and fitness activ-
sion of household activities may underestimate the total ity, which agrees with previous studies [14,17,32]. The
PA within women and result in misclassified as physi- Shanghai Women’s Health Study reported that women
cally not very active [26]. Further, cultural perspectives aged 40-70 years of age with more education were more
can influence LTPA [44]. In fact, Spanish people have a likely to practice sports, but widows/divorced/separated
poor attitude to change or improve their physical activ- were more likely to walk [17]. In contrast, Wong et al
ity as compared to Europeans [45]. In Spain, gender dif- reported that people with lower educational level spent
ferences in LTPA are in accordance with findings more time on walking than those with higher level [32].
previously reported by Cornelio et al [41]. Among behavioral factors, smoking and BMI > 28
We found that age ≥80 years, to be married, ≥ 2 co- were negatively associated with LTPA. These results
morbid chronic conditions and obesity were associated agree with previous studies showing that obesity was
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Table 3 Time trends by gender and age group in leisure time physical activity and physical fitness between 1987 and
2006
WOMEN Age group SNHS 1987 SNHS 1993 SNHS 95-97 SNHS 2001 SNHS 2003 SNHS 2006 P-value*
Leisure time physical activity+ 65-79 13.3 28.2 36.8 40.4 36.4 59.2 < 0.001
≥ 80 9.1 23.1 26.0 26.9 18.3 40.3 < 0.001
Total 12.7 24.2 35.1 38.2 32.1 54.6 < 0.001
Walking up 10 step+ 65-79 NA 86.5 87.9 87.6 88.2 85.6 0.056
≥ 80 NA 68.4 70.7 71.2 61.6 66.4 0.108
Total NA 83.8 85.3 85.0 81.8 80.9 0.401
Walking for one hour+ 65-79 NA 77.8 75.8 79.0 78.5 75.5 0.065
≥ 80 NA 53.6 44.4 53.5 42.6 45.3 0.385
Total NA 74.2 71.0 75.0 70.0 68.1 0.172
MEN Leisure time physical activity 65-79 26.6 45.2 56.7 60.5 45.0 73.0 < 0.001
≥ 80 18.9 49.0 41.7 46.8 33.1 58.4 < 0.001
Total 25.5 46.0 53.9 58.4 42.6 69.6 < 0.001
Walking up 10 step 65-79 NA 92.9 93.8 94.5 92.6 91.0 0.158
≥ 80 NA 80.5 82.5 82.9 77.0 74.7 0.502
Total NA 91.4 91.8 92.7 89.6 87.3 0.056
Walking for one hour 65-79 NA 87.7 88.6 88.3 87.8 84.7 0.072
≥ 80 NA 75.3 66.2 70.6 65.7 61.2 0.248
Total NA 86.3 84.8 85.7 83.4 79.4 0.066
P value for association between the prevalence of study variables and the SNHS (multivariate regression models)/NA: Not available.
+ Significant differences in the total prevalence of study variables between women and men

Figure 1 Time trends of Leisure Time Physical Activity (LTPA).

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Figure 2 Time trends of Walk 10 steps.

associated with lower activity [22,46]. In the longitudi- muscle strength [47]. Spanish sedentary older people
nal analyses of the CHIANTI study, obese older popu- exhibited lower education level in both genders. Seden-
lation with low muscle strength had steeper decline in tary men consume alcohol less frequently and have a
walking speed, walk 400 m or climb one flight on higher number of chronic diseases than women, while
stairs as compared with those without obesity or low sedentary older women are obese, have never smoked

Figure 3 Time trends of Walk 1 hour.

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Table 4 Logistic Regression Models for WOMEN

Leisure time physical activity Walking up 10 step Walking for one hour
Age group 65-79 1 1 1
≥ 80 0.43 (0.36-0.51) 0.27 (0.22-0.34) 0.23 (0.19-0.28)
Marital status Unmarried/widow/divorced 1 1 1
Married or living with couple 0.87 (0.75-1.00) 1.29 (1.06-1.58) 1.41 (1.19-1.66)
Educational level No studies 1 1 1
Primary education completed 1.15 (0.99-1.33) 1.64 (1.34-2.00) 1.28 (1.08-1.51)
Secondary education or more 1.13 (0.90-1.42) 1.48 (1.05-2.08) 1.28 (0.97-1.68)
Self rated health Very good/good 1 1 1
Fair/poor/very poor 1.13 (0.97-1.32) 0.22 (0.16-0.29) 0.19 (0.16-0.24)
Nª of chronic conditions None 1 1 1
1 0.89 (0.74-1.08) 1.50 (1.11-2.04) 1.33 (1.04-1.71)
≥2 0.74 (0.61-0.89) 1.19 (0.90-1.57) 0.93 (0.74-1.17)
Number of medications None 1 1 1
1 1.28 (0.96-1.72) 1.02 (0.56-1.84) 0.83 (0.52-1.30)
≥2 1.15 (0.87-1.53) 0.58 (0.33-1.02) 0.48 (0.31-0.72)
BMI Normal 1 1 1
Overweight 0.98 (0.84-1.15) 0.99 (0.79-1.27) 0.97 (0.79-1.18)
Obesity 0.77 (0.63-0.95) 0.60 (0.46-0.77) 0.56 (0.45-0.70)
Smoking habits Smoker 1 1 1
Ex Smoker 1.03 (0.60-1.77) 0.59 (0.24-1.45) 1.20 (0.60-2.42)
Non Smoker 1.37 (0.90-20.7) 0.51 (0.25-1.04) 0.86 (0.50-1.48)
Sleep habits (hours/day) <8 1 1 1
≥8 1.01 (0.88-1.15) 1.19 (0.99-1.43) 1.35 (1.15-1.58)
SNHS 1987 1 - -
1993 1.82 (1.40-2.36) 1 1
1995-97 2.82 (2.15-3.70) 0.98 (0.65-1.49) 1.44 (1.02-2.05)
2001 3.66 (2.86-4.67) 1.15 (0.78-1.69) 1.70 (1.24-2.34)
2003 2.53 (1.99-3.21) 1.20 (0.84-1.72) 1.59 (1.19-2.13)
2006 3.69 (2.89-4.70) 1.29 (0.90-1.86) 1.63 (1.21-2.19)
The results of the logistic models are shown as adjusted odds ratios (ORs) with 95% confidence intervals. Models adjusted by all variables shown in the table, no
significant interactions were found

and consumed more frequently 3 or more drugs than underestimate the benefits of exercise [50]. This may be
men [34]. related to the fact that this group is determined by anti-
Our results provide evidence that older people report- aging messages that appear in mass media [51], social
ing a fair/poor/very poor self-rated health status have [42] and cultural contexts [44]. They may have a ten-
difficulties in walking and climbing stairs. Self-perceived dency to integrate socially, avoiding showing they need
health status is considered as a reliable predictor of PA, help for anything [52]. In addition, elders may overesti-
walking decline and mortality in older people [6]. In mate the PA [18] which they practiced, or be unaware
fact, perceived poor health status has been associated of the recommendations or levels of exercise for effec-
with lower PA [33], as PA significantly correlates with tive results [14]. Other factors that may influence adher-
self-reported health in older adults [48]. ence to PA in the elderly are outcome expectations and
Our study has revealed an increase in LTPA during environmental barriers [53], self-efficacy [54]. It is also
the last 20 years, but not for the capacity to walk up ten possible that older people meet the PA recommenda-
steps or walk for one hour. The tendency to respond tions to maintain their health status but at the same
affirmatively to LTPA can be explained because older time have a sedentary lifestyle, and therefore their physi-
people sometimes have a negative opinion of those inac- cal fitness has not improved.
tive, and have their own beliefs about the effects of PA Finally, we should recognize some limitations of our
[49]. In addition, the less active older individual tends to study. First, discrepancies between trends of increase or
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Table 5 Logistic Regression Models for MEN

Leisure time physical activity Walking up 10 step Walking for an hour
Age group 65-79 1 1 1
≥ 80 0.61 (0.49-0.75) 0.37 (0.28-0.49) 0.30 (0.24-0.39)
Marital status Unmarried/widow/divorced 1 1 1
Married or living with couple 0.79 (0.65-0.95) 0.74 (0.54-1.02) 0.94 (0.73-1.22)
Educational level No studies 1 1 1
Primary education completed 1.27 (1.04-1.54) 1.68 (1.25-2.26) 1.46 (1.13-1.88)
Secondary education or more 1.13 (0.88-1.44) 1.64 (1.06-2.57) 1.29 (0.92-1.81)
Self rated health Very good/good 1 1 1
Fair/poor/very poor 0.91 (0.76-1.08) 0.17 (0.11-0.25) 0.16 (0.12-0.22)
Nª of chronic conditions None 1 1 1
1 1.10 (0.87-1.37) 1.45 (0.95-2.20) 1.52 (1.06-2.16)
≥2 1.13 (0.88-1.44) 1.12 (0.75-1.66) 0.97 (0.68-1.38)
Number of medications None 1 1 1
1 1.00 (0.76-1.32) 1.25 (0.57-2.71) 0.63 (0.35-1.15)
≥2 0.89 (0.66-1.18) 0.35 (0.18-0.71) 0.33 (0.19-0.59)
BMI Normal 1 1 1
Overweight 1.00 (0.84-1.22) 1.40 (1.02-1.91) 1.08 (0.83-1.41)
Obesity 0.66 (0.43-0.96) 0.92 (0.62-1.36) 0.70 (0.51-0.98)
Smoking habits Smoker 1 1 1
Ex Smoker 0.90 (0.72-1.13) 0.54 (0.33-0.87) 0.95 (0.66-1.36)
Non Smoker 0.79 (0.62-1.02) 0.66 (0.39-1.12) 1.41 (0.95-2.09)
Sleep habits (hours/day) <8 1 1 1
≥8 0.99 (0.84-1.17) 1.24 (0.93-1.65) 1.27 (1.00-1.60)
SNHS 1987 1 - -
1993 2.51 (2.03-3.11) 1 1
1995-97 3.35 (2.65-4.23) 1.01 (0.57-1.78) 0.81 (0.51-1.26)
2001 3.76 (3.04-4.66) 1.35 (0.89-2.02) 0.96 (0.69-1.35)
2003 1.99 (1.62-2.45) 1.18 (0.80-1.74) 1.01 (0.73-1.41)
2006 4.22 (2.85-5.59) 1.09 (0.74-1.62) 0.81 (0.58-1.13)
The results of the logistic models are shown as adjusted odds ratios (ORs) with 95% confidence intervals. Models adjusted by all variables shown in the table, no
significant interactions were found.

decrease in PA among studies may be related to the individuals can overestimate their participation in exer-
definition and measurement of LTPA and physical fit- cise, and underestimate sedentary behaviors [14,18],
ness [18], study designs, or the statistical analysis [51]. surveys are extremely useful for investigating patterns,
In the current study, we used a self-reported measure frequencies, and time trends. Finally, the use of objec-
of PA including two questions with 2 possible answers, tive measurements for assessing PA has changed over
which can have limited the assessment of activity and the last years, so the use of the same outcome for 20
exercise. Additionally, the SNHS only assessed LTPA years is difficult. Secondly, the study design does not
and PA; therefore, we cannot examine occupational, permit to establish a cause and effect relationship due
recreational, and transport-related PA independently. to the lack of longitudinal follow-up of the same indi-
In addition, the validity of the questions included in viduals. Nevertheless, the use of a national population-
the surveys have not been analyzed. The use of objec- based survey permits the inclusion of representative
tive measures could complement self-report data to national sample sizes. Despite these limitations this
avoid bias, i.e., quantification of physical activity level study provides additional insight into demographic
by calculating MET or using accelerometers [27]; how- aspects of LTPA and physical fitness in older adults
ever, this is not generally feasible in large-scale popula- for whom there is little information at population
tion surveys due to extensive costs. Further, even when levels, particularly in Spain.
Palacios-Ceña et al. BMC Public Health 2011, 11:799 Page 10 of 11
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Conclusion issues and research priorities. J Gerontol B Psychol Sci Soc Sci 2006, 6:
S352-S356.
Our study revealed an increase in LTPA, but not in phy- 4. Elsawy B, Higgins KE: Physical activity guidelines for older adults. Am Fam
sical fitness, from 1987 to 2006 in older Spanish people. Physician 2010, 81:55-9.
Older people (age ≥ 80 years), married, with a greater 5. Gregg EW, Cauley JA, Stone K, Thompson TJ, Bauer DC, Cummings SR,
Ensrud KE: Study of Osteoporotic Fractures Research Group: Relationship
number of co-morbid chronic conditions and obese of changes in physical activity and mortality among older women. J Am
exhibited a relatively lower LTPA. Similarly, older peo- Med Dir Assoc 2003, 289:2379-86.
ple (age ≥ 80 years, those taking a greater number of 6. Hirsch CH, Diehr P, Newman AB, Gerrior SA, Pratt C, Lebowitz MD,
Jackson SA: Physical Activity and Years of Healthy Life in Older Adults:
medications for chronic conditions, obese, and with Results From the Cardiovascular Health study. J Aging Phys Activity 2010,
worse self-perceived health status tended to have a rela- 18:313-334.
tively lower physical fitness. These results have potential 7. Boyle PA, Buchman AS, Wilson RS, Bienias JL, Bennett DA: Physical activity
is associated with incident disability in community-based older persons.
implications for health services, as identification of these J Am Geriatr Soc 2007, 55:195-201.
factors can help to prevent physical inactivity and 8. Byberg L, Melhus H, Gedeborg R, Sundström J, Ahlbom A, Zethelius B,
improve the health status of older people in Spain Berglund LG, Wolk A, Michaëlsson K: Total mortality after changes in
leisure time physical activity in 50 year old men: 35 year follow-up of
population based cohort. BMJ 2009, 338:b688.
9. Ueshima K, Ishikawa-Takata K, Yorifuji T, Suzuki E, Kashima S, Takao S,
List of abbreviations Sugiyama M, Ohta T, Doi H: Physical activity and mortality risk in the
PA: Physical activity; LTPA: Leisure time physical activity; SNHS: The Spanish Japanese elderly: a cohort study. Am J Prev Med 2010, 38:410-8.
National Health Surveys; ORs: Odds ratios. 10. Stessman J, Hammerman-Rozenberg R, Cohen A, Ein-Mor E, Jacobs JM:
Physical activity, function, and longevity among the very old. Arch Intern
Acknowledgements and funding Med 2009, 169:1476-83.
None 11. Demakakos P, Hamer M, Stamatakis E, Steptoe A: Low-intensity physical
activity is associated with reduced risk of incident type 2 diabetes in
Author details older adults: evidence from the English Longitudinal Study of Ageing.
1
Department of Health Science II, Universidad Rey Juan Carlos, Madrid, Spain. Diabetologia 2010, 53:1877-85.
2
Preventive Medicine and Public Health Teaching and Research Unit, 12. Motl RW, McAuley E: Physical activity, disability, and quality of life in
Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain. older adults. Phys Med Rehabil Clin N Am 2010, 21:299-308.
3
School of Public Health. Madrid. Spain. 4Department of Physical Therapy, 13. Caspersen CJ, Powell KE, Christenson GM: Physical Activity, Exercise, and
Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Physical Fitness: Definitions and Distinctions for Health-Related
Juan Carlos, Alcorcón, Madrid, Spain. Research. Public Health Rep 1985, 100:126-131.
14. Ashe MC, Miller WC, Eng JJ, Noreau L: Physical Activity and Chronic
Authors’ contributions Conditions Research Team: Older adults, chronic disease and leisure-
DPC conceived of the study, and participated in its design and coordination time physical activity. Gerontology 2009, 55:64-72.
and draft the manuscript. CAB carried out the acquisition of the data, 15. Centers for Disease Control and Prevention: Physical activity and health A
analysis and interpretation of data. She has been involved in revising it report of the Surgeon General. Atlanta: US Dept of Health and Human
critically. VHB participated in the design of the study and performed the Services; 1996 [http://www.cdc.gov/nccdphp/sgr/chap2.htm].
statistical analysis. PCG carried out the acquisition of the data, analysis and 16. Lim K, Taylor L: Factors associated with physical activity among older
interpretation of data. She has been involved in revising it critically. RJG people- a population-based study. Prev Med 2005, 40:33-40.
participated in the design of the study and performed the statistical analysis. 17. Jurj AL, Wen W, Gao YT, Matthews CE, Yang G, Li HL, Zheng W, Shu XO:
EPM carried out the acquisition of the data, analysis and interpretation of Patterns and correlates of physical activity: a cross-sectional study in
data. She has been involved in revising it critically. CFP conceived of the urban Chinese women. BMC Public Health 2007, 7:213.
study, and participated in its design and coordination and helped to draft 18. Merom D, Bowles H, Bauman A: Measuring Walking for Physical Activity
the manuscript. Surveillance- The effect of Prompts and Respondents’ Interpretation of
All authors read and approved the final manuscript. Walking in a Leisure-Time Survey. J Phys Activity Health 2009, 6:S81-S88.
19. Fors S, Lennartsson C, Lundberg O: Health inequalities among older
Authors’ information adults in Sweden 1991-2002. Eur J Public Health 2008, 18:138-43.
None 20. Murabito JM, Pencina MJ, Zhu I, Kelly-Hayes M, Shrader P, D’Agostino RB Sr:
Temporal trends in self-reported functional limitations and physical
Competing interests disability among the community-dwelling elderly population: the
The authors declare that they have no financial competing interests and Framingham Heart Study. Am J Public Health 2008, 98:1256-62.
non-financial competing interests. 21. Allman-Farinelli MA, Chey T, Merom D, Bowles H, Bauman AE: The effects
Conflict of interest: The manuscript, or parts of it, have not been and will of age, birth cohort and survey period on leisure-time physical activity
not be submitted elsewhere for publication. by Australian adults: 1990-2005. Br J Nutr 2009, 101:609-617.
Role of the funding source: We have not financial interest and we have not 22. Bromley C, Sproston K, Shelton N: The Scottish Health Survey 2003. Adults.
received direct o indirect funding, and there is not conflict of interest. Scotland: Scottish Executive 2005, 2: [http://www.scotland.gov.uk/Resource/
Doc/76169/0019729.pdf].
Received: 15 June 2011 Accepted: 13 October 2011 23. Carlson SA, Densmore D, Fulton JE, Yore MM, Kohl HW: Differences in
Published: 13 October 2011 Physical Activity Prevalence and Trends From 3 U.S. Surveillance
Systems: NHIS, NHANES, and BRFSS. J Phys Activity Health 2009, 6:S18-S27.
References 24. Center for Disease Control: Trends in leisure-time physical inactivity by
1. United Nations: Population Division: World Population Ageing 1950-2050. age, sex, and race/ethnicity-Unites Sates, 1994-2004. MMWR 2005,
New York: United Nations; 2002. 54:991-994.
2. Christensen K, Doblhammer G, Rau R, Vaupel JW: Ageing populations: the 25. Kurozawa Y, Hosoda T, Iwai N, Nose T, Yoshimura T, Tamakoshi A, for the
challenges ahead. Lancet 2009, 374:1196-1208. JACC Study Group: Levels of Physical Activity among Participants in the
3. Prohaska T, Belansky E, Belza B, Buchner D, Marshall V, McTigue K, JACC Study. J Epidemiol 2005, 15:S43-S47.
Santariano W, Wilcox S: Physical activity, public health, and aging: Critical
Palacios-Ceña et al. BMC Public Health 2011, 11:799 Page 11 of 11
http://www.biomedcentral.com/1471-2458/11/799

26. Orsini N, Bellocco R, Bottai M, Pagano M, Wolk A: Age and Temporal 47. Stenholm S, Alley D, Bandinelli S, Griswold ME, Koskinen S, Rantanen T,
Trends of Total Physical Activity among Swedish Women. Med Sci Sports Guralnik JM, Ferrucci L: The effect of obesity combined with low muscle
Exerc 2006, 240-5. strength on decline in mobility in older persons: results from the
27. Stamatakis E, Ekelund U, Wareham NJ: Temporal trends in physical activity InCHIANTI Study. Int J Obes 2009, 33:635-644.
in England: The health Survey for England 1991 to 2004. Prev Med 2007, 48. Chad K, Reeder BA, Harrison EL, Ashworth NL, Sheppard SM, Schultz SL,
45:416-423. Bruner BG, Fisher KL, Lawson JA: Profile of physical activity levels in
28. Simpson ME, Serluda M, Galuska DA, Gillespie C, Donehoo R, Macera C, community-dwelling older adults. Med Sci Sports Exerc 2005, 37:1774-84.
Mack K: Walking Trends Among U. S. Adults. The Behavioral Risk Factors 49. Wilcox S, Sharkey JR, Mathews AE, Laditka JN, Laditka SB, Logsdon RG,
Surveillance System, 1987-2000. Am J Prev Med 2003, 25:95-100. Sahyoun N, Robare JF, Liu R: Perceptions and beliefs about the role of
29. Kaplan MS, Newson JT, McFarland BH, Lu L: Demographic and physical activity and nutrition on brain health in older adults.
psychosocial correlates of physical activity in late life. Am J Prev Med Gerontologist 2009, 49:S61-71.
2001, 21:306-312. 50. Leavy B, Aberg AC: “Not ready to throw in the towel": perceptions of
30. Knuth AG, Hallal PC: Temporal trends in Physical Activity: A Systematic physical activity held by older adults in Stockholm and Dublin. J Aging
review. J Phys Act Health 2009, 6:548-559. Phys Act 2010, 18:219-36.
31. Lindström M, Isacsson SO, Merlo J: Increasing prevalence of overweight, 51. Wadsworth LA, Johnson CP: Mass media and healthy aging. J Nutr Elder
obesity and physical inactivity: Two population-based studies 1986 and 2008, 27:319-31.
1994. Eur J Public Health 2003, 13:306-312. 52. Gooberman-Hill R, Ebrahim S: Making decisions about simple
32. Pan SY, Cameron C, DesMeules M, Morrison H, Craig CL, Jiang XH: interventions: older people’s use of walking aids. Age Ageing 2007,
Individual, social, environmental, and physical environmental correlates 36:569-73.
with physical activity among Canadians: a cross-sectional study. BMC 53. Ayotte BJ, Margrett JA, Hicks-Patrick J: Physical activity in middle-aged
Public Health 2009, 9:21. and young-old adults: the roles of self-efficacy, barriers, outcome
33. Wong CH, Wong SF, Shen L: Correlates of Habitual Walking and Sports/ expectancies, self-regulatory behaviors and social support. J Health
Leisure-time Physical Activity in Older Persons in Singapore: Interaction Psychol 2010, 15:173-85.
Effects Between Educational Attainment and Gender. Ann Acad Med 54. McAuley E, May KS, Motl RW, White SM, Wójcicki TR, Hu L, Doerksen SE:
Singapore 2003, 32:801-6. Trajectory of Declines in Physical Activity in Community-Dwelling Older
34. Guallar-Castillón P, Santa-Olalla Peralta P, Banegas JR, López E, Rodríguez- Women: Social Cognitive Influences. J Gerontol B Psychol Sci Soc Sci 2009,
Artalejo F: Physical activity and quality of life in older adults in Spain. 64:543-50.
Med Clin (Barc) 2004, 123:606-10.
35. López-García E, Banegas-Banegas JR, Gutiérraz-Fisac JL, Graciani Pérez- Pre-publication history
Regadera A, Díez Gañán L, Rodríguez-Artalejo F: Relation between body The pre-publication history for this paper can be accessed here:
weight and health-related quality of life among the elderly in Spain. Int http://www.biomedcentral.com/1471-2458/11/799/prepub
J Obes Relat Metab Disord 2003, 27:701-9.
36. Rodríguez-Artalejo F, López García E, Gutiérrez-Fisac JL, Banegas Banegas JR, doi:10.1186/1471-2458-11-799
LaFuente Urdinguio P, Domínguez Rojas V: Changes in the prevalence of Cite this article as: Palacios-Ceña et al.: Time trends in leisure time
overweight and obesity and their risk factors in Spain, 1987-1997. Prev physical activity and physical fitness in elderly people: 20 year follow-
Med 2002, 34:72-811. up of the Spanish population national health survey (1987-2006). BMC
37. Garatachea N, Molinero O, Martínez-García R, Jiménez-Jiménez R, González- Public Health 2011 11:799.
Gallego J, Márquez S: Feelings of well being in elderly people:
relationship to physical activity and physical function. Arch Gerontol
Geriatr 2009, 48:306-1.
38. Instituto Nacional de Estadística: panish National Health Survey 2006.
Madrid, Spain: Spanish Goverment; 2006 [http://www.msc.es/estadEstudios/
estadisticas/encuestaNacional/encuesta2006.htm].
39. Ministerio de Sanidad y Consumo: Spanish National Health Survey 1987-
2003. Madrid, Spain: Ministerio de Sanidad y Consumo; 2004 [http://www.
msps.es/estadEstudios/estadisticas/estadisticas/microdatos/
frmBusquedaMicrodatos.jsp].
40. Román-Viñas B, Serra-Majem L, Ribas-Barba L, Roure-Cuspinera E, Cabezas C,
Vallbona C, Plasencia A: Trends in physical activity status in Catalonia,
Spain (1992-2003). Public Health Nutr 2007, 10:1389-1395.
41. Cornelio CI, García M, Schiaffino A, Borrás JM, Nieto FJ, Fernández E, for the
CHIS.FU Study Group: Changes in leisure time and occupational physical
activity over 8 years: the Cornellá Health Interview Survey Follow-Up
Study. J Epidemiol Community Health 2008, 62:239-244.
42. Gallant MP, Dorn GP: Gender and race differences in the predictors of
daily health practices among older adults. Health Educ Res 2001, 16:21-31.
43. Krause MP, Januário RSB, Hallage T, Haile L, Miculis CP, Gama MPR, Goss FL,
da Silva SGA: A comparison of Functional Fitness of Older Brazilian and
American Women. J Aging Phys Act 2009, 17:387-397. Submit your next manuscript to BioMed Central
44. Mathews AE, Laditka SB, Laditka JN, Wilcox S, Corwin SJ, Liu R, and take full advantage of:
Friedman DB, Hunter R, Tseng W, Logsdon RG: Older adults’ perceived
physical activity enablers and barriers: a multicultural perspective. J
• Convenient online submission
Aging Phys Act 2010, 18:119-40.
45. Varo-Cenarruzabeitia JJ, Martínez-González MA, Sánchez-Villegas A, • Thorough peer review
Martínez-Hernández JA, Irala-Estévez JJ, Gibney MJ: Attitudes and practices • No space constraints or color figure charges
regarding physical activity: situation in Spain with respect to the rest of
Europe. Aten Primaria 2003, 31:77-84. • Immediate publication on acceptance
46. Stenholm S, Rantanen T, Alanen E, Reunanen A, Sainio P, Koskinen S: • Inclusion in PubMed, CAS, Scopus and Google Scholar
Obesity history as a predictor of walking limitation at old age. Obesity
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