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LEVEL OF PHYSICAL ACTIVITY IN OLDER ADULTS RESIDING IN URBAN AREAS

Abstract

Introduction: The population of elderly in India has increased in the past few decades and is entailed to rise further in the coming years. Rise in life expectancy fails to ensure high health-related quality of life. Healthy ageing is an important factor affecting the quality of life. Physical activity promotes quality of life through healthy ageing. The goal of this study is to assess the adequacy and to understand the typology of physical activity levels performed by older adults residing in urban areas.

Methodology: 150 individuals, aged between 50 to 69 years, residing in urban areas of Maharashtra were interviewed using International Physical Activity Questionnaire (long form). Individuals with history of surgery or trauma in past 6 months, chronic respiratory, cardiovascular, neurological diseases, cancer and also the one’s using assistive devices for ambulation were excluded.

Results: 91.33% participants were physically active with 46%, 45.33% and 8.67% showing high moderate and low level of physical activity respectively, with garden and household related activities contributing (mean 1102.5MET minutes/week) a larger component of total physical activity.

Conclusion: Older adults living in the urban areas are performing satisfactory and above satisfactory levels of physical activity in their day to day lives. Transport-related PA remains the foremost participated activity in this age group whereas maximum energy expenditure is within the garden and household-related activities.

Key words: Older adults, physical activity, healthy ageing, IPAQ

Introduction

The elderly population in India has experienced dramatic demographic growth in the past few decades and continues to do so. The Report of the ‘Technical Group on Population Projections for India and States (2011-2036)’ claims to have 138 million elderly individuals in India in 2021 and is anticipated to grow to 173 million by 2026.[1, 2]This increase in the elderly population can be attributed to a fall in the mortality rate due to monetary well-being, advanced healthcare, and medical facilities. With increasing life expectancy, the concern is whether the added time consist years of healthy life and encourages a high health-related quality of life- especially with a concomitant rise in the prevalence of non-communicable diseases and the associated burden Physical activity reduces the hazards of non-communicable diseases and promotes general wellbeing.[3] The World Health Organization defines physical activity as “any bodily movement produced by skeletal muscles that require energy expenditure” and it refers to all movements including leisure time, transport-related, or work-related activities[4] Evidence from various researches supports the positive affiliation between high levels of physical activity, exercise participation and improved health in older adults.[5] Regular physical activity is secure for healthy and frail older adults and decreases the risks of developing significant cardiovascular and lifestyle diseases, obesity, falls, cognitive impairments, osteoporosis, and musculoskeletal weakness.[6]In this context, physical activity and healthy aging are becoming a crucial pillar of research and an objective for policy-makers throughout the world. Despite numerous benefits of healthy aging and physical activity, according to ICMR-INDIAB study (Phase-1) a large percentage of the population in India is inactive with fewer than 10% accomplishing the leisure-time physical activity.[7] Physical activity gradually declines up by 30%–50% between the ages of 30 and 80 years, as humans lose their strength and muscle mass. Furthermore, losses in muscular strength occur at an approximate rate of 12%–14% per decade after age 50 years.[8] Other elements like health problems, weight or pain issues, fear of falling, loneliness, loss of confidence, and zeal for a living make older adults more susceptible to lifestyle diseases. Besides this, the retirement transition in this age group is a vital life change affecting people’s lifestyles and behaviors. Urbanization is another factor influencing health; easy substitutions for vigorous activities have made the urban elderly more vulnerable to sedentary behaviors.[9] Physical activity is the need of the hour and an easy, reliable and affordable method of primordial prevention against several lifestyle diseases. Especially, in a developing country like ours with a rapidly growing population encouragement of physical activity specifically in the old age population and in the population about to enter old age can help reduce the health-related burden significantly. Although, there have been previous studies assessing the physical activity of the elderly there is a lack of data on their day-to-day performance and the specificity of activities. This study aims to study in detail the adequacy of the physical activity levels and their typologies to understand the pattern of coping strategies used by older adults to maintain their levels of physical activity into this next phase of their lives called old age

Need of Study

Although there have been previous studies assessing the physical activity of the elderly there is a lack of data on their day-to-day performance and the specificity of activities. This study aims to study in detail the adequacy of the physical activity levels and their typologies to understand the pattern of coping strategies used by older adults to maintain their levels of physical activity into this next phase of their lives called old age.

Research question:

Are the older adults living in urban areas performing adequate physical activity?

Hypothesis

Research/ Alternate Hypothesis: Inadequate physical activity in older adults residing in urban areas of Maharashtra.

Null Hypothesis: Adequate physical activity in older adults residing in urban areas of Maharashtra.

Aim

To assess the physical activity performed by older adults residing in urban areas using the International Physical Activity Questionnaire (IPAQ).

Objective

• To evaluate the amount of physical activity performed by older adults in MET minutes/week.

• To grade the physical activity levels performed as low/moderate/high based on MET minutes/week.

• To identify whether the physical activity performed by the older adults is adequate for their age.

• To categorize the physical activities performed by older adults into job related/ transportation/ household work/ leisure time activities.

Review of Literature

1. Assessment of physical activity in older Belgian adults: validity and reliability of an adapted interview version of the long International Physical Activity Questionnaire (IPAQ-L)

Veerle Van Holle et al

(April 2015)

434 individuals completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. IPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA. Criterion validity results suggest that IPAQ-L is more valid to measure older adults’ weekly minutes of total PA than weekly MVPA minutes.

2. Assessment of the Physical Activity of Elderly Population of Isfahan, Iran Eshaghi

Sayed Reza et al

(September 2011)

The aim of this study was to evaluate the physical activity of the elderly in Isfahan. This cross sectional study was carried out on 350 old residents of Isfahan using Rapid assessment of physical activity (RAPA) questionnaire to investigate the amount of physical activity. The study concluded that the level of physical activity in Isfahan is low and the high risk group needs more attention.

3. Assessment of physical activity and inactivity risk in geriatric population Dr. Ajit Dabholkar et al

(February 2018)

This study was conducted among the 100 individuals, aged above 60 years. It examined the sedentary time and low level of PA by using validated Rapid Assessment Disuse Index (RADI) and identifies the level of activity using International physical activity Questionnaire Short-Form (IPAQ-SF). The studies showed that females were more prone to sedentary lifestyle and are more under inactivity risk as compare to males. Therefore, concluding that males are more physically active than females.

4. Physical Activity Pattern in India Stratified by Zones, Age, Region, BMI and Implications for COVID-19: A Nationwide study

Vivek Podder et al.

(May 2021)

The study aimed to investigate the patterns of physical activity in India, stratified by zones, body mass index, urban, rural areas and gender. It as a survey to identify all individuals at a high risk for diabetes using Indian Diabetes Risk Score (IDRS), was followed by a two armed randomized yoga-based lifestyle intervention for primary prevention of diabetes. The study concluded 20% and 37% of the population in India are not active or mildly active, respectively and thus 57% of the surveyed population does not meet the physical activity regimen recommended by the World Health Organization.

5. Physical Activity Measurement in Elderly: The Indian Scenario Majeeda Shaheen et al

(January 2016)

This paper attempts to give an overview of the present condition of the sedentary elderly population in India. Physical activity in elderly is a less popular area of research, especially in a developing country like ours, where the population demographics are fast changing. Further work needs to be done to establish measurement techniques subjective/objective of the PA that are quick, appropriate and reliable for large samples of elderly population in epidemiological studies and surveys.

6. Health-related quality of life and associated factors in functionally independent older people

Monica Machon et al

(January 2017)

A cross-sectional study was conducted by face-to-face interviews with the selected individuals. HRQL was measured with the EuroQol-5D scale, consisting of a 5 item descriptive system and a visual analogue scale (VAS). The study identified a set of health, social and contextual variables as strongly related to HRQL in functionally independent community-dwelling older people. The results highlight the multidimensional nature of HRQL. They also reveal the importance of a comprehensive assessment of HRQL when designing adequate health-related programs aiming to enhance active and healthy ageing and delay the onset of dependence.

7. Physical Activity during the Retirement Transition of Men and Women: A Qualitative Longitudinal Study

Marco Socci et al

(August 2021)

Analyses were carried out within a three-year qualitative longitudinal study (2014-2016), which explored the individual experience of PA during the transition from work to retirement of 24 women and 16 men in Italy, with interviews carried out one year before and one and two years after retirement. Results show that preferred PA for both women and men was walking, along the transition to retirement. Over time, several participants replaced physically demanding activities with lighter ones.

8. Validity of the International Physical Activity Questionnaire (IPAQ) for assessing moderate-to-vigorous physical activity and sedentary behavior of older adults in the United Kingdom

Claire Cleland et al

(December 2018)

This study aimed to test the validity of the International Physical Activity Questionnaire in a group of older adults for both moderate-to-vigorous physical activity and sedentary behavior. The study found out that the IPAQ is better implemented in larger surveillance studies comparing groups within or between countries rather than on an individual basis and also suggested that the IPAQ validity scores could be strengthened by providing additional detail of types of activities older adults might do on a daily basis, improving recall; and it may also be necessary to provide an example of a daily break down of typical activities performed needs more attention to improve the physical activity.

9. Impact of physical activity on the risk of cardiovascular disease in middle-aged and older adults: EPIC Norfolk prospective population study

Sangeeta et al

(January 2018)

This study aimed to compare the association between different levels of physical activity and the risk of cardiovascular disease (CVD) in elderly to middle –aged individuals. It concluded that the association between physical activity and risk of CVD was significant in elderly and comparable with middle aged individuals. It also stated that modest levels of physical activity benefits in terms of CVD risk compared to complete inactivity.

10. Physical activities and quality of life among elderly population in urban slum of Bardhaman Municipality, West Bengal.

Dr. Sangita De et al

(May 2018)

Present study aimed to assess the extent and pattern of physical activity, quality of life and their association among elderly slum population in Bardhaman Municipality, West Bengal. Global Physical Activity Questionnaire (GPAQ) and World Health Organization Quality of Life Instrument – Older Adults Module (WHOQOL-OLD) was used. The study concluded that Physical activity is positively associated with quality of life of slum dwelling elderly. Improving the pattern and level of physical activities among elderly is thus emphasized.

11. Physical Inactivity among Adults Aged 50 Years and Older — United States, 2014

Kathleen B. Watson et al

(September 2016)

Approximately 28% of adults aged ≥50 years (31 million persons) were inactive. Inactivity increased with increasing age and BMI, and decreased with increasing levels of education. The prevalence of inactivity was higher among women than among men, and among Hispanics and non-Hispanic blacks compared with non-Hispanic whites. The prevalence was 10%–50% higher among adults who reported having had one of seven specific chronic diseases than among those who reported not having it. The prevalence among the 50 states and DC ranged from 18% to 39%. Results of this analysis are consistent with findings from a national survey showing these differences by demographic characteristics§ and by chronic disease status.

12. Physical activity and inactivity patterns in India – results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]

Ranjit M. Anjana et al

(February 2014)

Phase 1 of the ICMR-INDIAB study was conducted in four regions of India (Tamilnadu, Maharashtra, Jharkhand and Chandigarh representing the south, west, east and north of India respectively) with a combined population of 213 million people. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) in 14227 individuals aged ≥ 20 years. The study shows that a large percentage of people in India are inactive with fewer than 10% engaging in recreational physical activity. Therefore, urgent steps need to be initiated to promote physical activity to stem the twin epidemics of diabetes and obesity in India.

13. Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS survey

Jaya Prasad Tripathy

(August 2018)

A household survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals using the WHO STEPS questionnaire. No significant urban rural difference was noted in both sexes in all three domains of physical activity such as work, transport and recreation. However, rural females were found to be engaged in vigorous activity more than the urban females. Males reported high levels of physical activity in both the settings. Absence of recreational activity was reported by more than 95 % of the subjects. Higher prevalence of obesity was seen among urban females as compared to their rural counterparts.

Materials and Methodology

• Study design: Cross sectional study

• Sampling technique: Snowball sampling

• Study setup: Online and physical mode.

• Sample Size: 150

• Inclusion Criteria:

- Older adults between the ages of 50 to 69 years.

-Older adults residing in urban areas.

• Exclusion Criteria:

-Older adults with major illnesses like cancer, chronic obstructive pulmonary disease, unstable angina.

-Older adults with Neurological conditions like Stroke, Spinal cord injury, Parkinson’s disease, Motor Neuron Disease, Alzheimer’s disease.

-Older adults who have undergone any major surgery or trauma in past 6 months. ̵ Wheelchair bound older adults.

• Procedure:

-Permission and approval was obtained from the Institution Ethical Committee.

-Participants were recruited from the urban areas of Maharashtra through snowball sampling.

-Demographic data like name, age, gender, address and work profile was obtained.

-Participants were interviewed using International Physical Activity Questionnaire (long form)

-Data was collected and the results were analysed using IPAQ long form scoring guidelines and Microsoft excel’s descriptive statistics.

Results

Graph 1: Levels of PA

46% participants showed high PA, 45.33% showed moderate PA and remaining 8.67% showed low PA when calculate with IPAQ.

Graph 2: Gender wise distribution of PA

Majority of male participants (29.33%) showed moderate PA followed by high PA (18.67%) and the least (5.33%) showed low PA. In females, majority depicted high levels of PA (27.33%) followed by moderate levels of PA(16%) and only a small group depicted low levels of PA (3.33%).

Graph 4: Total data analysis of PA

80.67% participants were involved transport-related PA followed by garden-household related PA 60.67% and leisure-related PA 60% almost equally. Least percentage of 33.33% were involved in work-related PA.

Discussion

The goal of this study was to assess the adequacy of physical activity levels in their day-to-day lives and understand the typology of the physical activities performed. The data analysis from 150 participants showed that a large proportion of 91.33% is physically active, matching the WHO’s criteria of performing 150-300 minutes of moderate intensity aerobic physical activity per week. On categorizing the physical activity performed by the elderly as job-related, transport-related, garden and household-related, and leisure-related according to the IPAQ; a large number of individuals (80%) were involved in transport-related PA followed by garden-household(60.67%) and leisure related PA(60%) almost equally and least proportion(33.33%) were involved in work-related PA, retirement is the main factor affecting it. Most of the physical activity was performed in the garden and household-related activities (mean 1102.5MET minutes/week). While assessing the gender-wise distribution in males and females, garden and household-related PA remained highest (mean 2121.21MET minutes/week in males and 2131.41MET minutes/week in females) followed by transport-related PA in males (mean 1249MET minutes/week) and leisure-related PA in females (mean 1202.64MET minutes/week). This gender discrepancy in the levels of PA is attributed to the differences in the need for the tasks performed under gender roles. High levels of physical activity in females correspond to high levels of vigorous household chores like cooking, sweeping, cleaning, mopping, and washing which is considered more of an obligation to female participants while is a choice for male participants.[10]Transport-related PA which was more common in male participants compared to their female counterparts included walking as the primary mode of transport. It included tasks like visiting and/or accompanying their spouses to the hospital, bank-related tasks, shopping in local markets, and picking up and dropping their grandchildren from place to place. Leisure-related PA showed a higher interest in females than males; walking was the most common activity seen in this age group which included morning walks, evening walks, and walking after dinner. Yoga was another leisure time activity that some participants performed regularly. Participation in sports and other recreational activities remains fairly low in Indian elderly population. Work-related physical activity was mainly observed in the younger age group. Although a majority of participants had a sitting or standing job, work-related walking was an important aspect contributing to their work-related PA. Participation in physical activity in older adults is influenced by several variables including demographic factors such as gender, education, and marital status; environmental factors like social aid from family members or 16 friends, availability of provisions for exercise and/or recreational activities, and personal determinants mainly one’s motivation, self-efficacy, and self-regulation skills.[6]The awareness and perception of physical activity in the elderly play an important role in their performance. The study by SK Veluswamy et.al showed that there is low awareness of chronic disease-related benefits of physical activity and participants do not see a need to increase their physical activity level.[11] Another study by MahrsTräff, A.et.al identified that there were several perceptions of physical activity amongst the elderly and the professionals they come across, elderly and professionals do not define physical activity in the same way.[12] Therefore, creating awareness about role of physical activity in lifestyle diseases for prevention of co morbidities and improvement of health will motivate older adults to engage actively in physical activity and exercise behavior. Older adults are influenced to increase their activities if facilitated by clinicians, keeping expenses low and enjoyment high, facilitating team-based activities, and elevating self-efficacy for exercise.[6] Solutions like conducting physical activity programs in diverse settings and utilizing multiple channels of communication will help to alleviate some of these barriers. National Program of Health-Care for the Elderly in India: A Hope for Healthy Ageing is one such program designed for the Indian elderly population. Strategies to achieve the goals of the program include community-based fitness approach at PHCs, dedicated facilities at the district hospitals, strengthening of regional medical institutes to provide care and education about geriatric medicine, promotion of public-private partnerships for geriatric health, and continuous monitoring of the program.[13]There was a significant positive relationship between social media use and the awareness of health in older adults.[14]Therefore, domains like the peer support internet, social media, gamification, and technology should be encouraged to increase the engagement and motivation of the elderly towards physical activity. Furthermore, studies on physical activity interventions should examine whether they will benefit from collaborative, social problem-fixing models of behavior change that link individual and group-mediated interventions which will have to be made viable for population-based health promotion activity programs. Contradicting the previous reviews of literature, this study provides an insight into the adequate levels of physical activity performed by the elderly adults in urban areas of Maharashtra when compared with the World Health Organization’s physical activity guidelines. Physical activity in the elderly yet remains a less popular area of research hence, further work needs to establish measurement techniques (subjective/objective) of the PA that are quick, appropriate, and reliable for samples of the elderly population in epidemiological studies and surveys.

Conclusion

Majority of elderly living in the urban areas are performing satisfactory and above satisfactory levels of PA in their day to day lives. Majority of participants were involved in transport related PA. Majority of PA in MET minutes/week were performed in garden and household related activities. The aerobic activity performed by the elderly is in forms of vigorous, moderate and walking activities are age appropriate when compared with WHO’s criteria.

Clinical implication

Awareness and participation of elderly in physical activity can be modified by making exercises enjoyable through use of technology like gamification and social media. Peer and group intervention along with the social support from family and friends can help us achieve the goal of healthy ageing in our elderly population.

Limitations of the Study

IPAQ does not emphasize on the strength and flexibility aspect of the PA performed it is difficult to compare the results with the age wise physical activity criteria of the World Health Organization.

Further Scope of the Study

Further research is needed to establish the detailed analysis and need of inculcating moderate to vigorous forms of exercises/ activities in this population and studying about the factors affecting their involvement

References

1. Government of India, Department of Health and Family Welfare: Report of Population projections for India and States 2011-2036. (New Delhi)(Dated 9th July 2020). Available from: https://main.mohfw.gov.in/sites/default/files/Population%20Projection%20Report%202011-20 36%20-%20upload_compressed_0.pdf

2. Vikaspedia, Senior citizens: Status in India, available from: https://vikaspedia.in/social-welfare/senior-citizens-welfare/senior-citizens-status-in-india

3. Saqib ZA, Dai J, Menhas R, Mahmood S, Karim M, Sang X, Weng Y. Physical Activity is a Medicine for Non-Communicable Diseases: A Survey Study Regarding the Perception of Physical Activity Impact on Health Wellbeing. Risk Manag Healthc Policy. 2020 Dec 11;13:2949-2962. doi: 10.2147/RMHP.S280339. PMID: 33335436; PMCID: PMC7737939. World Health Organization, Physical Activity (Internet) 20th November 2020. https://www.who.int/news-room/fact-sheets/detail/physical-activity.

4. World Health Organization, Physical Activity (Internet) 20th November 2020. https://www.who.int/news-room/fact-sheets/detail/physical-activity

5. Taylor D Physical activity is medicine for older adults Postgraduate Medical Journal 2014;90:26-32.

6. McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology. 2016 Jun;17(3):567-80. doi: 10.1007/s10522-016-9641-0. Epub 2016 Mar 2. PMID: 26936444; PMCID: PMC4889622.

7. Anjana, R.M., Pradeepa, R., Das, A.K. et al. Physical activity and inactivity patterns in India results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act 11, 26 (2014).

8. Milanović Z, Pantelić S, Trajković N, Sporiš G, Kostić R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8:549-56. doi: 10.2147/CIA.S44112. Epub 2013 May 21. Erratum in: Clin Interv Aging. clin interv aging. 2014;9:979. PMID: 23723694; PMCID: PMC3665513.

9. Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S, Prasad R. Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results 20 from a cross-sectional STEPS survey. BMC Public Health. 2016 Aug 18;16(1):816. doi: 10.1186/s12889-016-3489-8. PMID: 27538686; PMCID: PMC4989330.

10. Cerrato J and Cifre E (2018) Gender Inequality in Household Chores and Work-Family Conflict. Front. Psychol. 9:1330. doi: 10.3389/fpsyg.2018.01330

11. Veluswamy, S.K., Maiya, A.G., Nair, S. et al. Awareness of chronic disease related health benefits of physical activity among residents of a rural South Indian region: a cross-sectional study. Int J Behav Nutr Phys Act 11, 27 (2014). Mahrs Träff, A., Cedersund, E. & Nord, C. Perceptions of physical activity among elderly residents and professionals in assisted living facilities. Eur Rev Aging Phys Act 14, 2 (2017).

12. Mahrs Träff, A., Cedersund, E. & Nord, C. Perceptions of physical activity among elderly residents and professionals in assisted living facilities. Eur Rev Aging Phys Act 14, 2 (2017). https://doi.org/10.1186/s11556-017-0171-9

13. Verma R, Khanna P. National program of health-care for the elderly in India: a hope for healthy ageing. Int J Prev Med. 2013 Oct;4(10):1103-7. PMID: 24319548; PMCID: PMC3843295.

14. Fu L, Xie Y. The Effects of Social Media Use on the Health of Older Adults: An Empirical Analysis Based on 2017 Chinese General Social Survey. Healthcare (Basel). 2021 Sep 1;9(9):1143. doi: 10.3390/healthcare9091143. PMID: 34574917; PMCID: PMC8465959.

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5/17/2022
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