"More of the same is not enough": New Directions in Ageing and Physical Activity

Lead Research Organisation: University of Bath
Department Name: Department for Health

Abstract

The issue:

There are currently more people over the age of 60 than ever before. The Office of National Statistics have projected that the number of people age 60 years and over will increase by 50% in the next 25 years. These demographic changes are important because people generally become less physically active as they grow older. This can be detrimental to their health and well-being and has subsequent health and social care costs.
Researchers have been investigating the relationship between physical activity and health for a long time. Consequently, much is known about which diseases can be prevented through physical activity, and how much and how often activity should be undertaken. This information is useful, but it does not negate the fact that there are still lots of older people who are inactive.

Recently, leading scientists have said that if we are to encourage people to integrate health behaviours like physical activity into their everyday life, conducting research to reconfirm that physical activity is beneficial is not enough. Instead, they say that we need to know more about the different environments, which can enable or deter physical activity in older age and shape how it is experienced. This includes people's physical environments (e.g. their access and proximity to woodlands, parks etc.) and also their social and cultural environments (e.g. the impact of their ethnicity, gender, interaction with healthcare etc.). Social scientists are well qualified to investigate issues like these.

Our response:

Our seminar series will bring together academics from different subject areas (e.g. sociology, psychology, geography, sport and health sciences), policy makers, health and social care practitioners, physical activity and sport providers, and those working within the voluntary and statutory sectors. Each seminar will focus on a specific issue relevant to the physical, social and cultural environments that can impact upon physical activity (PA) in older age. Specifically; (i)competitive sport in later life, (ii)physical activity during lifecourse transitions, (iii)how gender impacts upon physical activity involvement - and vice versa, (iv)experiences of physical activity amongst hard to reach groups (e.g. ethnic minorities), (v)community based initiatives to promote physical activity, (vi)E-health, (vii)PA in the outdoor natural environment, (viii)the process of using research to inform policy and practice.

Leading experts from the UK and abroad will share their knowledge and direct discussions with seminar participants. This process will advance what we currently know about the topic and also identify aspects that we don't know about that require more research. It will also enable a large group of people (from research, policy and practice backgrounds) with a shared commitment to healthy ageing to establish themselves as a 'network'. The network members will continue to communicate and collaborate with each other both during and beyond the lifetime of the seminar series.

Who will benefit and how:

The seminar series is intended to have strong and distinctive impacts in academic, policy and user communities. This will be achieved by advancing understanding of (i)physical activity engagement in older age in ways that go beyond 'how much' and 'how often', (ii)the value of using different disciplines (i.e. subject areas) and research methods to generate knowledge about this topic. Policy contributions will be made regarding how best to promote healthy ageing, through physical activity involvement. Impact will also occur through the inclusion of older participants in the co-production of research knowledge, and in the training of early career researchers to continue championing this research area. Working closely with Core Partners (British Heart Foundation, Birmingham Public Health, Sporting Equals) will enhance the research teams understanding of the relationship between research and policy.

Planned Impact

The seminar series will create the first substantive contribution in its area. It will establish new directions in research and practice around ageing and physical activity (PA) through a focus on how social, cultural and physical environments can enable and deter activity happening and shape how it is experienced.

To maximise the impact, we have engaged with partners throughout its design. Initial discussions took place at the Moving Stories project (Ref: ES/I009779/1) end of award event held in July 2013. Non-academic beneficiaries are numerous and varied (e.g. AgeUK, Sport England, Sporting Equals, Women's Sport and Fitness Foundation, Natural England, Ramblers Association, National Trust, British Heart Foundation). Many will contribute to the programme as invited speakers and continue their involvement throughout the execution and dissemination stages of the series.

Main beneficiaries and how will they benefit from the seminar series? (refer also to Academic Beneficiaries, Pathways to Impact, Case for Support):

1) NHS/Public Health: The seminars will provide discussion and clarification of evidence and facilitate the development of transferable, systematic research methodologies. This will allow bodies such as the new local Health and Wellbeing Boards to tailor their evidence, communication and practice regarding PA in older age (e.g. Seminars 1,2,4,5,8). A focus on E/M-Health (e.g. Seminar 6) will be especially valuable for attempts to design and implement increasingly cost effective forms of (preventative) health care.

2) Social care: The outcomes of these seminars will provide the resources needed to identify environments, which are welcoming to older adults within specific social groups, and communities (e.g. certain ethic groups, gender, care settings), who are typically excluded from PA interventions and therefore the benefits they may afford (e.g. Seminars 3,4).

3) Local authorities (e.g. Sport Partnerships, Environment & Planning departments): Seminars will help to inform local and regional programmes aimed at improving community health and wellbeing through the provision of opportunities to be PA (e.g. Seminars 2,5), including those associated with green infrastructure, environmental interventions, open space and access (e.g. Seminar 7).

4) Business and Industry (including sports clubs, leisure providers): Understanding social, cultural and physical environments that impact on older adults experiences of and involvement in PA has direct relevance to marketing strategies and product / service development (e.g. Seminars 1,2,3). Impact here will be further realised through two additional 'Business & Enterprise' events hosted by the University of Exeter (refer to Pathways to Impact, Justification of Resources).

5) Community Groups: Good quality evidence could be used to justify and support community group applications for funding for the preservation and development of local activity groups (as proposed under the Localism Bill). These groups will also benefit from knowledge of evidence-informed community-based initiatives designed to promote active ageing (e.g. Seminar 4). The applicants have established relationships with a variety of Community Groups (e.g. Cornwall Neighbourhoods for Change, Westbank Healthy Living Centre).

6) Government departments (e.g. Department of Health [primary]; Department of Work & Pensions [secondary]) tasked with managing and protecting the wellbeing of older adults particularly through PA: Value will be derived in the ways outlined above. In addition, the seminars will provide a forum for policy perspectives and evidence needs relative to PA in older age to be identified and where appropriate, critiqued, in order to ensure effective distribution of resources (e.g. Seminar 8).

The translation of knowledge to our beneficiaries will be supported through the appointment of a Knowledge Transfer Fellow (refer to Pathways to Impact; Justification of Resources).

Related Projects

Project Reference Relationship Related To Start End Award Value
ES/M001709/1 01/10/2014 03/01/2016 £30,013
ES/M001709/2 Transfer ES/M001709/1 04/01/2016 14/02/2018 £20,457
 
Description NB - THIS AWARD WAS TRANSFERRED FROM THE UNIVERSITY OF EXETER IN JANUARY 2016. PREVIOUS REFERENCE "RES/M001709/1" THIS IS NOT A SEPARATE AWARD AND ALL KEY FINDINGS, IMPACTS ETC. ARE LISTED IN THIS ENTRY.

All of the proposed seminars took place.

A number of key issues have been identified at the intersection of physical activity in older age with a range of specific contexts. These are outline in the final report produced for this seminar series: https://www.dropbox.com/s/21wyfihs1jn018u/A%20Spotlight%20on%20Social%20Context.pdf?dl=0 Alternatively, they can be read below.
1. Physical activity across the life course: Physical activity as a regular part of everyday life seems like a fairly straightforward aspiration but in reality, it can be a challenge to create an active lifestyle. Older adults are no exception. We can develop a greater understanding of an older adult's current physical activity levels if we can place them in the social context of change and continuity over the life course.
An active lifestyle may be the result of prior life time experiences and opportunities to be active in earlier life. Often individuals encouraged to be active at an early age learn skills and have enjoyment from participation, want to continue being active as they grow older. Similarly, negative experiences of physical activity in earlier life can in uence con dence and prevent individuals from perceiving themselves as exercisers in later life.
Throughout the life course, a whole range of events and episodes can challenge people's inclination and ability to be active. Moving house, changing jobs, losing a job, raising a family can disrupt previously established routines and networks that support an active life style. During busy periods, spending time on physical activity can seem a luxury rather than a necessity. For some, this can evoke feelings of guilt. Caring for a spouse can be exhausting and the practicalities of nding time or leaving the home for activity seem impossible. Equally in these scenarios, 'time (left) together' can feel precious. Being away to participate in exercise - while in some instances provides important respite from care work - can seem indulgent and wasteful.
Changed circumstances, or 'turning points' in a life - whether it's entering parenthood, retiring from work, receiving a diagnosis or experiencing bereavement - form the tapestry of life. Research has shown that they
can also be important moments for introducing new activities.
The need for variety is great. For example, while gentle walking and a club environment will suit some, others may be seeking solitude, personal challenge, or competition. It is important to resist assumptions concerning 'what would be good' for older people, without asking them.
The extent to which people feel able to be active throughout adulthood and into later life can be in uenced by the attitudes of those around them. Speci cally, misplaced perceptions concerning older adults being unable to physically exert themselves, that 'being sporty' is not ladylike, or that youth alone is the time for learning new skills, can restrict what older adults believe is possible in later life. Recommendations for policy and practice include:
• Promoting physical activity in later life should be tailored to older people's life histories, while equally fostering imagination and a sense of possibility regarding what can be accomplished in the future.
• Much as we might strive towards life-long participation in physical activity, the reality is more often one of ebbs and ows. Accepting that physical activity participation uctuates, that di erent strategies are needed at di erent times, and that it's never too late to (re)start are all important messages to communicate.
• For some, being part of an established activity club that meets regularly helps to legitimise time away from other demands in life. Clubs can provide safety, solidarity and a sense of social identity. Having a pre-set 'club night/ morning' can also be helpful for supporting a routine.
2. Engaging older men in physical activity: Globally, men tend to die younger than women, and older men's health and wellbeing is a concern. We know that physical activity can have bene cial health e ects but know little about what older men actually do, how
they experience di erent physical activity environments, and the role of 'masculinity' in shaping their activity choices and practices.
We do know that older men may face challenges in performing valued masculine identities, for example based around sport, physical labour and sexual performance, and that 'greying masculinities' may be di cult for men to accept (Drummond, 2003).
Physical, environmental and psychological constraints can inhibit older men from going to the gym or participating in team sports and may result in sedentary lifestyles, excessive alcohol consumption or low mood. However, there are a number of recent research projects and health initiatives focused on older men and physical activity, which point to how this constituency can be better engaged in various endeavours which bestow physical and psychological bene ts.
For many men, sport is an important source of identity, status and wellbeing. That is why several health programmes have explicitly targeted men with
sport in mind. For example, interventions focusing on weight management
and healthy lifestyles have traded on the popularity of football to attract and engage men in physical activity and nutrition sessions.
Such programmes are successful in helping men to lose weight and live more healthily, while also promoting camaraderie between men, social bonding, humour and boosts to self-esteem.
Reaching older men at risk of social isolation and physical and psychological problems requires sensitivity to masculinity issues and knowledge about local community norms, interests and assets. Interventions with older men can
be e ective if framed in 'male-friendly' ways (e.g. sport), avoiding jargon or (mental) health terminology and featuring local champions and mentors who men might trust and respond to.
Examples of good practice
Football Fans in Training (FFiT; Hunt et al., 2013), Motivate (Gough, Seymour- Smith & Matthews, 2016), and Premier League Health (Robertson et al., 2013) have all e ectively traded on the popularity of football to attract and engage men in physical activity and nutrition sessions.
FFiT: sp trust.org.uk/projects/football-fans-in-training
Age UK have successfully addressed the tension between love for football and age-related decline in mobility: Walking Football. Here, the focus is on what men can do rather than what they nd di cult, an assets-based approach which has proved very popular. AgeUK have found that when teaming up with local professional clubs, communities readily take to walking football, with men getting involved in organising games, leagues and associated social events. Walking Football: ageuk.org.uk/information-advice/health-wellbeing/ tness/ walking-football
For men not so interested in sport, the 'Men's Sheds' movement brings older, vulnerable men together in community centres ('sheds') where they are encouraged to make or x things, which may then be sold or donated to the local community (Cordier & Wilson, 2012).
Men in Sheds: menssheds.org.uk Recommendations
• Create opportunities for men to socialise with other men in a safe, friendly setting.
• Trade on the popularity and importance of sport to target speci c groups of men.
• For others, brand initiatives to focus on, for example, learning about the local, changing environment, and cementing a social identity.
• Intersperse activities with conversation and humour. 3. Natural environments: An active space for older adults? Outdoor environments could play an important role in supporting physical activity as we get older. Although the evidence for this is quite mixed, it is developing rapidly (a brief evidence summary on natural environment and physical activity more generally is available - Natural England, 2016).
To facilitate and promote activity across the life course, outdoor environments must be attractive, safe, and good quality. But these environments do not all have to be the same, nor do they need to huge areas of rolling green countryside!
Research has shown that bene ts can be gained from a wide range of environments and activities. For example, 'walkable' cities could promote everyday opportunities to walk from place to place; urban parks and gardens can support a range of informal and formal activities; 'blue space' (coasts, riversides, canals, lakes) can provide attractive places to walk, run, and swim. Nature-based activity - especially in association with water - has been highlighted for its value in terms of enjoyment, pleasure and engagement with 'place' (Humberstone, 2015).
These opportunities to support activity in older age could be capitalised upon through physically modifying our environments, increasing accessibility, and providing speci c programmes and activities within di erent places. However, it also seems crucial that we thoroughly understand relevant social processes and people's individual contexts to ensure that the opportunities of our everyday environments are inclusive, and do not lead to exacerbation of socio-economic and other inequalities. Visual impairment is particularly relevant here because it a ects 1 in 5 people aged 75 and over.
Examples of notable research and good practice
The Mood Mobility & Place research project has been exploring how places can be designed collaboratively to support outdoor activity, health, wellbeing and community engagement as people age. It has produced guidance on intergenerational co-design for age-friendly places, emphasising the importance of collaboratively improving older people's experience of pedestrian mobility.
Mood Mobility & Place: sites.eca.ed.ac.uk/mmp
Environmental Volunteering presents an opportunity for a number of social and health bene ts associated with outdoor activity, and The Conservation Volunteers (TCV) Scotland project has focussed e orts on capitalising on this in later life.
TCV Scotland: tcv.org.uk/scotland/feel-good/ageing-well
Parkrun is a free 5km run held in local parks and outdoor settings around the UK. In 2016, Sport England launched an 18-month scheme to support more people with sight impairment to take part in Parkrun.
Parkrun: parkrun.org.uk
The Sensing Nature research project is examining the diverse sensory experiences people have with nature, and how nature-based environments can be used to support wellbeing among people with sight loss. Visit their Blog to access a range of resources to support inclusion.
Sensing Nature: sensing-nature.com/news
Recommendations
• Planners and public open space managers should consider how development and management of outdoor spaces can support and encourage activity across the life course
• Refer to design guidance for the creation of 'age friendly' places
• Engage with the full range of 'users' of the outdoors to create inclusive spaces meeting multiple needs
• Seek opportunities to promote parks, gardens, footpaths etc. as spaces open to all for activities, especially walking 4. Digital self-tracking in older age. Digital health technologies are now a core mechanism through which people manage their health. These include a broad range of digital devices, software and platforms not only providing health information, but also capacities for users to self-track, monitor and regulate their bodies and behaviours and share data with others.
At the 2017 Consumer Electronics Show, Samsung surprised business- watchers with a shift in market development plans. Expected to focus on robots, they instead announced a focus on wearable health devices, such as tness trackers, believing that (according to their CEO) "an aging society will help this market segment grow more quickly" (Maslakovic, 2017).
In contrast to the ways that self-tracking technologies are discussed when younger users are envisioned, the focus when it comes to older users is on health rather than performance, and on producing data to help motivated ageing individuals mitigate risks for, or identify onset of, age-related decline.
Little is known about how older adults perceive digital self-tracking devices or how these individuals build the use of them into their day to day lives. Emerging research in this area suggests that older adults who self-track their activity rarely view the number of steps taken as being connected to anything other than that particular day. Data on heart rate, however, is viewed as being re ective of one's overall health status.
Positive feedback received through a device when goals are reached is generally welcomed, yet may not compel individuals to do things di erently and enact change in their daily routines. "Bad days" - when step counts are low - are also easily discounted by older users, who rarely hesitate to suspend tracking when other life events take over.
Rapid growth within the self-tracking industry has not been matched by research examining the social context of digital self-tracking in older age. Key questions remain regarding how older adults interact with these technologies, the ethical implications of data gathering and sharing, and the manner in which these devices become part of ageing and everyday life - watch this space!
Notable research:
Ageing + Communication + Techonologies (ACT) is a multi-methodological research project that brings together researchers and institutional community partners to address the transformation of the experiences of ageing with the proliferation of new forms of mediated communications in networked societies. ACT: actproject.ca
The Digital culture and quanti ed ageing research project will examine age and age-related function with a focus on the ways that self-tracking technologies and digital apps are used to create new modes and styles of measuring, calculating, storing and sharing information about ageing. 5. Minority Elders: The pro le of the older population of Britain is changing as we see the minority communities who moved to Britain in the decades from 1950-1980 (approximately) from the Caribbean and South Asia (notably India, Pakistan and Bangladesh) moving into old age.
Overall, 18% of the white British population are aged 65+ compared with 14% for the African Caribbean group; 8% for Indians and 4% each for both
the Pakistani and Bangladeshi populations. However, it is clear that future decades will see an increasing diversity in terms of ethnicity amongst the older population in Britain (Centre for Policy on Ageing, 2010). When thinking about the promotion of physical activity we must take this increasing diversity into account.
Physical activity has been described as 'the best treatment for aging' given the well-established bene ts of physical activity for health and well-being across the life course (Cassel, 2002). Inequalities in physical activity seen in earlier phases of the life course are maintained into old age.
We know that physical activity decreases as people grow older, that men are more active than women and that the most deprived groups are less active (Olanrewaju et al., 2016). Yet we know far less about how physically active minority elders are because of the comparative recency of the 'ageing' of these groups.
How physically active are minority elders? This is not an easy question to answer because studies often focus on a single minority group such as the three South Asian groups (India, Pakistan or Bangladesh) rather than making comparisons across all communities.
Using the data we have, it is clear that minority elders are less physically active than the majority community (Long & Hilton, 2009). This di erential is in the range of 20-80% less active depending on how physical activity is recorded (self-report or objective measures) and the way that it is reported (e.g. proportion meeting physical activity guidelines or total physical activity.) Again, these are broad-brush estimates and we know that women are less active than men.
There are 5 key factors linked with physical (in)activity for older people
1 Personal (values and beliefs, expectations of ageing and psychological factors)
2 Resources (social, health and socio/economic material)
3 Family (values, norms and expectations of older adulthood)
4 Environmental factors (urban, rural, facilities, access)
5 Wider society (culture, media, global (health) economy/science)
When looking at increasing physical activity among BME elders, it is important to identify the in uences on physical activity that are speci c to them and those which are more generic to older people or re ect the in uence of deprivation. Distinguishing between these di erent in uences is important if we are going to be able to design and deliver successful interventions to promote physical activity in minority groups.
Examples of Good Practice and Notable Research:
AgeUK. Engaging faith and BME communities in activities for wellbeing. Fit as a Fiddle; bit.ly/2Ab2X7X
McBarnett, O. (2010). Movers & Shakers in Buckinghamshire: an action research pilot project involving Asian and Caribbean communities, Ethnicity and Inequalities in Health and Social Care, 3(3), pp.33-37, doi.org/10.5042/eihsc.2010.0508
Thompson, J. (2014). Ageing in a multicultural/superdiverse society: New challenges, new dimensions. Birmingham Policy Commission. Available at: bit.ly/2B9Sxcu
Exploitation Route Developments have primarily been in the form of collaborative relationships, within the research team and also with external partners. Specifically:

1. Much stronger partnership between Janice Thompson and Professor Steven Loy at California State University, Northridge (speaker at 'Building sustained partnerships and sharing resources' seminar), currently seeking funding for his MSc student to do a PhD here in the UK, in partnership with Birmingham City Council Active Parks and Birmingham Open spaces leads (seminar series partners and speakers).

2. Based on work they do to include older adults in outdoor physical activity programmes, Birmingham Open Spaces and Local Parks are now options at Birmingham University (co-applicant Janice Thompson) for Undergraduate and Postgraduate Taught students to access for internships and placements. This is on-going work, and should lead to more research and teaching/training collaborations moving forward.

4. Cassandra Phoenix and Christina Victor were invited as expert advisors to Haringey Council's Adult and Health Scrutiny panel tasked with reviewing its approach to increasing physical activity among older adults. Panel co-ordinator learned of CP's expertise via reputation (word of mouth) and Seminar Series website.
Sectors Communities and Social Services/Policy,Healthcare,Leisure Activities, including Sports, Recreation and Tourism

URL http://www.seminars.ecehh.org
 
Description Findings from this seminar have been communicated with a number of non-academic groups (refer to Key Findings), it is too early to comment on final societal or economic impacts this may be having. Policy - Findings were discussed with and used to inform recommendations by Haringey Councils part of the Physical Activity & Older People's Scrutiny Report: http://www.minutes.haringey.gov.uk/ieListDocuments.aspx?CId=128&MId=7753&Ver=4 (see agenda item 11).
First Year Of Impact 2017
Sector Leisure Activities, including Sports, Recreation and Tourism
Impact Types Policy & public services

 
Description Invited advisor to evidence gathering panel (Haringey Council)
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description Article for The Conversation (Improving with age - our perception of growing old needs some get up and go) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Invited contribution to The Conversation . This has currently read by over 8000 people around the world. The Story has been picked up by The Independent and The Western Australia News. A link to the article was Tweeted 110 times, shared on Facebook 315 times and shared 18 times on Linkedin.
Year(s) Of Engagement Activity 2016
URL https://theconversation.com/improving-with-age-our-perception-of-growing-old-needs-some-get-up-and-g...
 
Description Article for The Conversation (The social barriers to an active society are being ignored) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Approx. 6000 read this article and it also led to a vast number of Tweets, which enabled a discussion around the social barriers impacting older adults experiences of physical activity to continue within a broader sphere. Awareness of this issues was heightened.
Year(s) Of Engagement Activity 2017
URL https://theconversation.com/the-social-barriers-to-an-active-society-are-being-ignored-77526
 
Description Images of Research Competition (Highly Commended) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Approx. 100 people attended an Exhibition at the Edge Arts Centre, University of Bath as part of the Images of Research Competition at the University of Bath. My image was highly commended and displayed on the University website thereafter. As a consequence of this event, I was approached by the Conversation to submit an article on perceptions of ageing.
Year(s) Of Engagement Activity 2016
URL https://www.flickr.com/photos/uniofbath/26718056902/in/album-72157667954297595/
 
Description Information Booklet Produced (Spotlight on Social Context) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A summary report of the seminar series was produced and disseminated to physical activity providers and 3rd sector organisations working with older adults. It is too early to know of any tangible impact this has had.
Year(s) Of Engagement Activity 2018
URL https://ageingpa.tumblr.com
 
Description Invited Keynote presentations (BASES Sport Psychology Division Day) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 50-100 researchers and sport/exercise practitioners attended this presentation. The audience reported their views had been challenged because it is rare that they consider ageing, nor social dimensions of ageing and physical activity (instead focusing primarily on sports performance and younger age groups).
Year(s) Of Engagement Activity 2017
URL http://www.bases.org.uk/News/successful-bases-psychology-division-day-with-great-workshops-and-speak...
 
Description Launch of Ageing & Physical Activity Blog site 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact A blog site was developed to communicate important outcomes from the Seminars to a broad and largely non-academic audience. The blog was visited by a member of Haringey Council's Adult's and Health Scrutiny Panel, who subsequently invited C. Phoenix to contribute to evidence gathering sessions re community level physical activity interventions.
Year(s) Of Engagement Activity 2016
URL https://ageingpa.tumblr.com