EXERCISE AND QUALITY OF LIFE
Research article
Volume 3, No. 2, 2011, 19-30
UDC
796.035-053.88(495)
PHYSICAL ACTIVITY OF GREEK OLDER
ADULTS AGED 65 AND OVER
Maria Michalopoulou*
Department of Physical Education and Sport Science
Democritus University of Thrace
Vassiliki Zisi
Department of Physical Education and Sport Science
University of Thessaly
Stavroula Stani, Christina Kiriazi and Efthimis Kioumourtzoglou
Department of Physical Education and Sport Science
Democritus University of Thrace
Abstract
Physical activity (PA) levels of community-dwelling adults aged 60 and over were
assessed in Greece, in order to determine age and gender effects. PA was assessed using the PA
Scale for the Elderly in
591 persons (287 males and 304 females), (Ã=74.04, SD=5.46).
Participants were assigned into two age groups: A=65-75 and B=76-86 years. According to two
way ANOVA, no significant differences were reported in total PA between men and women
(p>.05) even though a significant age effect was reported with participants in Group A having
higher scores than participants in Group B
(p<.001). Men reported greater participation in
recreational activities of moderate intensity (p<.001) and in exercises for muscular strength and
endurance (p<.05). Women were more active in PA related to household (p<.001). Age effects
resulted in favor of older adults in Group A 61-70 years when compared to older adults in Group B
for walking, for recreational activities and for housework (p<.001). In conclusion, both gender
and age affect PA participation of older adults in Greece.
Keywords: elderly, older adults, PASE, PA levels, age and gender effects
Introduction
According to CDC (2002) PA is any bodily movement produced by skeletal muscles that
results in an expenditure of energy (expressed in kilocalories) and includes a broad range of
occupational, leisure time and routine daily activities. These activities can require light, moderate
* Corresponding author. Department of Physical Education and Sport Science, Democritus University of Thrace,
Komotini, 69100 Greece, e-mail: michal@phyed.duth.gr
© 2010 Faculty of Sport and Physical Education, University of Novi Sad, Serbia
M. Michalopoulou et al.
or vigorous effort and can lead to improved health if they are practiced regularly. Numerous
research studies have reported many health and performance related benefits of engaging in
regular PA, particularly for older adults and for the least active segments of the population
(Shephard, 2002). A linear reduction in mortality risk has been suggested with increased levels
of PA in older adults (Dishman, Washburn, & Heath, 2004, Craig, Russell, Cameron, &
Beaulieu, 1997) and a threshold of about 1,000 kcal per week was accompanied by a 20% to
30% reduction in mortality risk (Lee, Hiesh, & Paffenbarger, 1995). Physical inactivity is also
recognized by the AHA and WHO as a major independent risk factor for coronary heart disease
(CHD) (Fletcher et al, 1996; Bijnen, Caspersen, & Mosterd, 1994). Physical inactivity in men
has been strongly related to high risk for CHD (Lakka, et al., 1994; Morris, Clayton, Everit,
Semmence & Burgess, 1990; Paffenbarger, Hyde, Wing & Hsieh, 1986; Paffenbarger et al.,
1993) but on the other hand this relation is less clear for women (Blair, Kohl, & Barlow, 1993;
Haapanen, Miilunpalo, Vuori, Oja & Pasanen, 1997; Sesso, Paffenbarger, Ha & Lee, 1999).
Individuals that developed CHD had lower participation during their free time in PA /sports but
no differences were reported between men and women (Folsom et al., 1997). The importance of
PA for maintaining good health for women has been presented in a longitudinal study where a
negative relation was detected between participation in PA and breast cancer occurrence in
70.000 postmenopausal women (McTierman et al., 2003). PA contributes also in reducing the
occurrence of other cerebrovascular diseases and stroke (Fagard, 2001) and regular PA of
moderate or high intensity may limit the risk for diabetes type II by 25% to 50% (Dishman, et
al., 2004).
Limited PA reflects 50% of the limitations in functional capacity where the other 50% of
the limitations that the older adults face are the result of increasing age (Hirvensalo, Rantanen, &
Heikkinen, 2000). Low levels of PA in older adults lead to limited independence (Gularnik,
Ferruci, Simonsick, Salive & Wallace, 1995) and to increased need for care services (Horgas,
Wilms, & Bates, 1998).
The intensity of PA is considered to play an important role in determining positive health
effects. Participation in vigorous PA (> 6 MET) was associated with a decreased risk in all-cause
mortality, but no benefits were reported for participation in light or moderate intensity PA (Lee,
Hsieh, & Paffenbarger,
1995). Older men that reported participation in vigorous physical
activities (> 8.4 MET) (climbing stairs, organized sports and mountain hiking) had a decreased
mortality risk of
25 % - 30% (Paffenberger, et al.,
1986). Additionally an increase in
participation in PA of older men for the previous five years from ìseldomî to ìvery frequentlyî
resulted in a 44% reduction in all cause mortality risk (Blair, Kohl, & Barlow, 1993).
The content, the intensity and the amount of PA seem to change in relation to the age and
gender of older adults. Previous studies showed rates of physical inactivity are higher for women
when compared to men and for the oldest individuals when compared to younger older adults
(Craig, et al., 1997; Kamimoto, Easton, Maurise, Husten & Macera, 1999; USDHHS, 1999). An
epidemiological study in U.S concerning the prevalence of physical inactivity in adults aged 65
and older reported that 37% of older men and 23% of older women engaged in regular leisure-
time PA ( LTPA = participation for 30 min or more at least 3 times per week during the part 2
weeks). The prevalence of LTPA was lowest for both men and women among those who were
oldest, were black had less education, rated their health as ìfair to poorî had activity limitations,
were smokers, had less exercise knowledge and reported greater stress (Yusuf et al., 1996). In
Canada, the population group of older adults with low income was the least physically active as
well as the fastest growing in number population group (Craig & Cameron, 2002).
In Canada, percentages of older women in comparison to older men were lower for
participation: in vigorous PA (20% women ñ 24% men), in moderate intensity PA (26% women
ñ 27% men), as well as in low intensity PA (19% women ñ 20% men) (Craig, et al., 1997).
Additionally during their free time older men participated more than women in physical
activities (Mensink, Deketh, Mul, Schuit & Haffmeister, 1996).
20
Physical activity of Greek older adults
The percentage of total population aged 65 and over for Greece has been reported 17.3 %
and it was the second highest percentage in the world after Italy (18.1%), (Kinsella, & Velkoff,
2001). According to previous studies performed in Greece women in a family setting that take
care of others were the least physically active segment of the population, with the lowest
percentage of participation in recreational physical activities (Alexandris, & Caroll, 1998).
According to Harahousou & Kambitsis (1993), limited participation in PA reported by Greek
older adults is related to social and educational factors that exclude participation in sports and
PA from their lifestyle. In particular older women had the lowest scores in participation in sports
and recreational physical activities and instead preferred to participate in physical activities of
daily living of low intensity, to watch TV, to visit friends and attend mass. The results of a more
resent study in Greece (Michalopoulou, Zisi, Malliou & Godolias, 2004) suggested that older
adults participated in activities of low intensity (housework and walking) and reach the levels of
moderate to low PA. Until today no data was available concerning age and gender effects on the
patterns of PA of older adults in Greece using a self report measure. The aim of the present study
was to assess PA participation of older adults in Greece and determine possible age and gender
effects in relation to the intensity and the content of the physical activities.
Methods
Participants
Subjects in this study were 591 older adults aged M 74.04, SD = 5.46 years, 287 males
(M = 74.54 + 5.54 years) and 304 females (M = 73.56 + 5.35 years). For the purpose of this
study subjects formed 2 age groups A = 65-75 and B = 76 - 86 years. Participants were randomly
selected to take part in this study and they were residents of different areas of Greece (Attika,
Hlia, Rodopi, Arta and Xanthi). They were recruited through Local Recreational Centers for the
Elderly that exist in every Greek City.
Weight and height were measured to the nearest 0.1 Kg and to the nearest 0.01 m
respectively using a wall-mounted stadiometer. Table 1. includes age and physical characteristics
of the older men and women that participated in this study.
Table 1
Age and physical characteristics of the male and female participants
Men
Total
Group A
Group B
N
287
153
134
Age (years)
74.54 ± 5.54
70.29 ± 3.08
79.39 ± 3.30
Weight (kg)
80.19 ± 12.71
79.23 ± 12.10
81.28 ± 13.34
Height (m)
1.68 ± 0.71
1.69 ± 0.07
1.68 ± 0.07
BMI
28.38 ± 4.15
28.19 ± 4.06
28.58 ± 4.26
21
M. Michalopoulou et al.
Table 1 (continued)
Women
Total
Group A
Group B
N
304
189
115
Age (years)
73.56 ± 5.35
70.24 ± 3.24
79.01 ± 3.24
Weight (kg)
74.52 ± 12.43
74.38 ± 10.58
74.75 ± 15.05
Height (m)
1.58 ± 0.12
1.59 ± 0.07
1.58 ± 0.17
BMI
29.36 ± 4.56
29.39 ± 3.94
29.31 ± 5.45
Instruments and Procedures
Physical Activity Scale of the Elderly
Physical Activity Scale of the Elderly (PASE; Washburn, Smith, Jette & Janney, 1993) is
a 12 item scale that measures the average number of hours per day spent participating in leisure,
household and occupational physical activities over the previous
7 day period. Under the
category of leisure time activity, frequency and duration of participation in the following five
activities were assessed: walking outside the home, light sport/recreation moderate
sport/recreation strenuous sport/recreation and muscle strength/endurance exercises. Frequency
of participation was assessed by asking respondents how often they are engaged in the activity
over the part week. They responded using the following 4-point scale: 0= never; 1= seldom/1-2d;
2 = sometimes/3-4d; and 3 = often/5-7d. Duration was assessed by asking participants on the
average, how many hours per day they spent on that activity. Responses were indicated using a 4
point scale: 1 = less than 1 h; 2 = 1 but less than 2h; 3 = 2- 4 h and 4 = more than 4h. By using a
conversion table
(Washburn, & Flicker,
1999) those categorical indices of frequency and
duration were used to calculate the average daily frequency of participation for each activity. To
ensure that participants correctly classified their sport and recreational activities as light,
moderate or strenuous participants recorded the specific activities in which they participated.
Under the category of household physical activities, participation in six activities was assessed:
light housework, heavy housework or chores, home repairs, lawn work or yard care, outdoor
gardening and caring for another person. Using a binary scale (2= yes, 1 = no) respondents
indicated whether they engaged in these behaviors over the past 7 days. Under the category of
work related PA participants indicated whether they worked for pay or as a volunteer (1 yes 0 =
no). The total PASE score can be computed by multiplying the amount of time spent in each
activity (hr/week) by the item weights and summing over all activities. The item weights are
originally based on comparison with physical activities estimated with 3-day motion sensor
counts, 3-day PA diary and global activity assessment (Washburn et al., 1993). The validity of
this questionnaire has been reported as good (r =.65) and the reliability also (r = .75) (Washburn,
& Flicker, 1999). Gender specific correlation coefficients have been reported 0.79 for men and
0.68 for women
(Schuit, Schouten, Westerterp, & Saris,
1997). The reliability of this
questionnaire in Greek population has been tested in a pilot study where 15 older men and 15
women were tested twice with a period of three weeks and it was proven very good (r = .79)
(Michalopoulou et al., 2006).
22
Physical activity of Greek older adults
Procedure
In order to obtain the data all questionnaires were completed using face to face interview
technique after asking for verbal and written ñsigned consent from the participants. The
collection of data included initially the completion of the questionnaire related to
sociodemographic information. A second questionnaire was used to obtain information related to
health status. Chronic illness was assessed be 12 specific disease questions (yes ñ no form).
Anthropometrical data was then collected as weight (0.1 Kg) and height (0.01m). Data collection
was completed with the completion of the PA Scale for the elderly. When participants had
limited reading and/or writing skills the interviewer completed the questionnaires for them. All
data collection tool place in a separate room in the local Recreational Center for the Elderly that
exists in every Greek city and its duration never exceeded 30 min.
Analysis of Data
Descriptive statistics (mean values and frequency analysis) were performed on physical
and demographic characteristics of the participants. Two -way Analysis of Variance (2 x 2) was
used in order to assess ìageî and ìgenderî effects on total PA score. A Two ñway MANOVA
was used to assess ìageî and ìgenderî effects on the following dependent variables: walking,
light PA related to sports/recreation, moderate PA related to sports/recreation, strenuous PA
related to sports/recreation, PA related to muscle strength and endurance exercises and PA
related to housework or chores and taking care of others. The level of significance was set at p =
0.05.
Results
According to the results of frequency analysis 18.7% of the participants were high-school
graduates,
65.1% of the participants were elementary school graduates and
16.2% of the
participants had not completed the primary level of education. Only 1.8 % of the participants
were still working and 98.2% were retired. Additionally 37.2% of the participants were in the
past working in professions that included strenuous PA
(e.g. farmer, construction worker,
industrial worker) 22.5% were involved in professions that required moderate physical effort
(e.g. postman, waiter, machinery operator),
16.9% of the participants were involved in
professions that included sitting and/or standing light physical effort (e.g. cashier, office clerk
with general responsibilities) and 13.4% of them were involved in professions that included only
sitting activities (e.g. driver, office clerk, office supervisor). The majority of the participants
were married 63.6%, 27.6% were widowed, 5.5% were divorced and 3.3% had never married.
Health status was considered very good for 12.1% of the participants, good for 31.7%, fair for
27.8% and bad for 28.4% of the participants.
Age and gender effects in Physical Activity
In order to determine age and gender effects a two-way ANOVA (age groups: ¡= 65-75,
and ¬ 76-86 years by gender: men, women) was performed on the dependent variable of total
PA. According to the results of the analysis no significant interaction was reported for the factors
ìageî and ìgenderî (F1,587= 1.312, p>.05, Á2=.20). The factor ìageî had a significant main effect
(F1,587 = 71,118, p<.001, Á2 = .11) with participants in group A being significantly more active
when compared to participants in group B (Graph 1). On the contrary no significant main effect
was also revealed for the factor ìgenderî (F1,587 = 0.51, p>.05, Á2 = .21). Mean values are
presented in Figure 1.
23
M. Michalopoulou et al.
Figure 1. Total physical activity score (PASE) for all participants according to gender and age
Women
150
142,4
127,6
123,9
130
Men
1 02,9
110
65-75
90
76-86
70
50
Women
Men
65-75
76-86
According to the results of two ñway MANOVA no significant interaction was reported
for the factors ìgenderî and ìageî for all the dependent variables included in the analysis. Main
effects were recorded for the factor gender for recreational PA of moderate intensity
(F1,587=11.988, p<.001, Á2=.03) and for participation in muscle strength and endurance exercises
(F1,587=5.800, p<.05, Á2=.02) with men being significantly more active when compared to
women in this study. Additionally women were more active than men in regards to light
housework (F1,587=17.470, p<.001, Á2=.03), to lawn work or yard care (F1,587 = 5.243, p<.05,
Á2=.01) and to outdoor gardening (F1,587 = 6.685, p<.01, Á2=.01) /Figures 2 and 3/.
Figure 2. differences in physical activity related to housework and carrying for others between
men and women in both age groups
1 50
Gr oup A Group B Total
1 30
111,97
1 10
104,58
102,55
92,48
87,08
90
78,67
70
50
W omen
Men
Figure 3. PASE scores for men and women in both age groups in walking, recreational physical
activities and exercise
25
Men
Women
20
Group A
Group b
15
10
5
0
Walking
Light
Moderate
Strenuous
Exercise
Recreational Activities
24
Physical activity of Greek older adults
For the factor ìageî significant main effects were reported for walking (F1,587 = 12.289,
p<.001, Á2=.07), for light recreational PA (F1,587 = 9.281, p<.01, Á2=.04), for moderate intensity
recreational PA (F1,587 = 4.890, p<.05, Á2=.02), and for strenuous sport/recreational activities
(F1,587 = 8.543, p<.01, Á2=.04). Additionally as far as the variables of house work and carrying
for another person are concerned the effect of factor ìageî was significant for the following
variables: light housework (F1,587 = 8.612, p<.01, Á2=.02), heavy housework (F1,587 = 16.003,
p<.001, Á2=.03), home repairs (F1,587 = 14.580, p<.001, Á2=.03), lawn work or yard care (F1,587 =
29.014, p<.001, Á2=.05), outdoor gardening (F1,587 = 12.687, p<.001, Á2=.02), caring for another
person (F1,587 = 7.518, p<.01, Á2=.02). All statistically significant differences were in favor of
Group A when compared to Group B (Table 2).
Table 2
Mean values of PASE in different physical activity scores according to age group
Group A
Group ¬
Total
à ± SD
à ± SD
à ± SD
House work and carrying for
108.66 ± 40.86
82.5 ± 47.16
97.66 ± 45.46
others
Walking
19.48 ± 18.33
14.43 ± 15.79
17.35 ± 17.47
Light recreational activities
4.34 ± 9.40
2.26 ± 6.07
3.46 ± 8.22
Moderate recreational
2.62 ± 9.61
1.36 ± 5.66
2.09 ± 8.20
activities
Strenuous recreational
1.09 ± 4.21
0.25 ± 2.02
0.73 ± 3.48
activities
Muscle strength/ endurance
0.22 ± 1.49
0.33 ± 1.80
0.27 ± 1.63
exercises
*p<.05, **p<.01
Discussion
According to the results of this study women and men similar PA scores a finding that is
not in accordance with those of numerous previous studies where in most cases older men are
more active when compared to older women
(Craig et al.,
1997; Jones et al.,
1998;
Michalopoulou et al., 2006; Yusuf et al., 1996). This difference may be due to differences in the
instrument ñ questionnaire used for assessing PA of older adults. The majority of the
questionnaires used in previous studies were designed in order to record typical differences in
the physical activities of younger adults and middle aged adults and might not be suitable for
recording the physical activities that older adults participate at (Shephard, 2002). Additionally
most of these instruments have not assessed or emphasized PA resulting from transportation,
household activities or other domestic activities such as care-giving and these activities may be
particularly important and more common in the lives of women and thus underestimate PA
levels in older women. The PASE questionnaire that was used in this study includes questions
that assess the above activities
(house work and caring for others) and have a significant
contribution to the total PA score especially for women. According to Washburn et al., (1993)
who constructed PASE, this instrument was designed to overcome the above problems inherent
in existing methods of assessing PA in older adults by including questions related to moderate
and strenuous PA performed as part of housework and carrying for others. In the study of Schuit
et al. (1997), women participated more in physical activities related to house work and caring for
25
M. Michalopoulou et al.
other and thus were more active when compared to men a finding that is being supported by the
results of our study.
In more detail, the differences in PA sub scores that were recorded in the present study in
favor of women when compared to male participants include light house work, outdoor
gardening and yard care. The above findings led us to the conclusion that the advantage of
women over men in PA was mainly the result of PA related to housework, an advantage that
persists in both age groups. In a study with frail older men that lived independently (Hachisuka,
Tsutsui, Furusawa, & Ogata, 1999), had lower levels of PA when compared to frail older women
of the same age.
Differences in favor of men were recorded in the present is study for activities performed
outside the home environment, that is recreational physical activities of moderate intensity and
for participation in muscle strength and endurance exercises. This finding has been reported in
the literature before since, where older men are more frequently found outside their home
participating during their free-time in physical activities of moderate intensity (Dallosso et al.,
1998). In recreational activities of low and high intensity the scores for men and women were not
different and the respective scores were relatively low when compared to the scores for walking,
another for of activity where no gender differences were reported in this study. This finding is in
accordance with those of previous studies that mention that the elderly perform engage in mostly
at physical activities alone and when they are at home (Horgas, et al., 1998). They devote a
significant percentage of their free time in watching TV and only a very small percentage of
them engage in physical activities (Crespo, Keteyian, Heath, & Sempos, 1996). Additionally,
walking represents the form of physical activity that older adults prefer irrespective of gender
and age (Craig, & Cameron, 2002) supporting the finding that walking was the form of physical
activity with the second highest PA sub scale scores recorded for the participants in this study,
following the sub scale of housework and taking care of others.
In relation to age and PA participation (total PA score), older adults in Group A (65-75
years) had the higher PA scores when compared to older adults in Group B (76-86 years). These
findings are supported by previous studies according to which PA is reduced when age increases
for older adults (Craig, et al., 1997; Kamimoto et al., 1999; USDHHS, 1999; Jones et al., 1998).
The conclusions presented by the above cross-sectional studies were based on comparisons
performed between younger and older adults and not between different age groups of older
adults.
Additionally, differences in PA sub scales, in relation to its content and the intensity were
reported between the two age groups of this study for walking and light and moderate intensity
recreational physical activities and for participation in exercises for muscular strength and
endurance. Previous studies using different age groups of elderly participants (Avlund et al.
2004), reported that older adults aged 70-79 years do not significantly decrease walking as a
form of PA when compared to younger groups of older adults. This lack of accordance between
the findings of our study and those of previous ones, may reflect the different age groups being
studied. Further more, participants in Group B were less active when housework and carrying
for another person was concerned reflecting their limitation in performing the basic and
instrumental activities of daily living required in daily life due to limitations in their functional
abilities and other health problems that they face (Jack, & Luigi. 2003).
In conclusion older women and men had similar PA scores (total PA) and age had a
significant effect on their total PA score. The majority of the PA variables used in assessing
different in content and intensity physical activities were lower for the older participants (age 76-
86) when compared to participants in group A (65-75 years). The highest PA scores in this study
were recorded for the sub scales assessing housework and carrying for another person and the
lowest for the sub scales assessing strenuous recreational PA and participation in exercises for
the improvement of strength and endurance. Walking on the other hand was the only activity
26
Physical activity of Greek older adults
were relatively high scores were recorded for both men and women and for participants in both
age groups. The findings that support the notion that PA is related to the maintenance of good
physical condition and health (Shephard, 2002) does not seem to affect the lifestyle of Greek
older adults especially those above the age of 76 since the scores obtained were relatively low. In
general they prefer recreational activities of low intensity and men participate more than women
in recreational activities of moderate intensity and in muscular strength and endurance exercises.
Future intervention attempts should take into consideration the above findings when addressing
the issue of health enhancing physical activity promotion addressed to the older adults in Greece.
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Submitted April 3, 2011
Accepted May 16, 2011
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