The Gerontologist
cite as: Gerontologist, 2016, Vol. 00, No. 00, 1–10
doi:10.1093/geront/gnv689
Advance Access publication February 13, 2016
Research Article
Perceptions of Sedentary Behavior Among Socially
Engaged Older Adults
Toshoya Mcewan, BHSc,1 Linna Tam-Seto, BA, BSc OT, MSc OT,2 and Shilpa Dogra, PhD*,1
Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, Canada. 2School of
Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada.
1
*Address correspondence to Shilpa Dogra, PhD, Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St N.,
Oshawa, Ontario L1H-7K4, Canada. E-mail: [email protected]
Received July 14, 2015; Accepted October 8, 2015
Decision Editor: Barbara J. Bowers, PhD
Abstract
Purpose: To better understand the perceptions of sedentary behavior, its pros and cons, and the barriers associated with
reducing sedentary time as it pertains to older adults.
Design and Methods: Four focus group sessions were conducted with older adults (n = 26). Each focus group lasted
approximately 45 min, was led by an experienced qualitative researcher, and utilized probing questions on the definition
of sedentary behavior, pros and cons of sedentary behavior, and programming needs for sedentary time reduction. Sessions
were recorded and transcribed verbatim. Two researchers independently extracted data from the transcripts and identified
major themes and subthemes. Data on sociodemographics and current activity levels were collected via questionnaires.
Results: Participants were 74 ± 8.5 years old and were primarily women (77%). They self-reported sitting for 5.6 ± 1.7 h per day
and engaging in physical activity for 172 ± 115 min/day. Four themes were identified. The first theme indicated that older adults
have varied definitions of the term sedentary behavior and that they have a negative perception of this term. The second theme
indicated that participants perceived social, cognitive, and physical benefits to the sedentary activities in which they engaged,
and that these activities were meaningful. The third theme indicated that physical health was the only perceived disadvantage of
engaging in sedentary activities. Finally, the fourth theme indicated that there were several perceived barriers to sedentary time
reduction, both person and environment related.
Implications: These findings have implications for use of terminology in policy and public health strategies targeting sedentary time reduction in older adults.
Key words: Sitting, Physical activity, Health
Regular physical activity is associated with significant
health benefits across the life span. Among older adults, it
has been shown to play an important role in prevention
of chronic disease (Chodzko-Zajko et al., 2009), biopsychosocial aspects of successful ageing (Liffiton, Horton,
Baker, & Weir, 2012), and quality of life (Swift et al., 2013).
Despite the many documented benefits, older adults have
the highest levels of physical inactivity and are the most
sedentary age group (de Rezende, Rey-Lopez, Matsudo,
& Luiz, 2014). In fact, recent data indicate that 93.6%
of older adults are sedentary for 8 or more hours per day
(Copeland, Clarke, & Dogra, 2015).
The term “sedentary” represents activities that are performed in a seated or reclined position and are associated
with low energy expenditure (Owen et al., 2011; Tremblay,
Colley, Saunders, Healy, & Owen, 2010). Sedentary behavior is negatively associated with a diverse range of health
outcomes in older adults (Dogra & Stathokostas, 2012;
Owen, Sparling, Healy, Dunstan, & Matthews, 2010). It
is an independent risk factor for chronic cardiometabolic
© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
For permissions, please e-mail: [email protected].
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disease, cancer, and all-cause mortality, and it is a distinct
risk factor from physical inactivity (Harvey, Chastin, &
Skelton, 2013; Owen et al., 2010; Tremblay et al., 2010).
There is also a growing body of evidence on the psychosocial consequences of sedentary time. For example, more
sitting is associated with psychological distress, depression,
anxiety, somatization, and sleeping problems (Asztalos,
Cardon, De Bourdeaudhuij, & DeCocker, 2015). Somewhat
counterintuitively, recent research shows that some seated
activities, such as playing board games, doing crafts, reading,
and computer use, have a positive association with health
status (de Rezende et al., 2014; O’Neil & Dogra, 2015).
Further, certain sitting activities reduce the risk of dementia, improve cognitive functioning, and provide vast forums
for social interaction (Basak, Boot, Voss, & Kramer, 2008;
Bleakley et al., 2015; Nimrod, 2010; O’Neil & Dogra, 2015;
Phelan, LaCroix, & Larson, 2004). Kikuchi and colleagues
(2014) identified sedentary activities of older adults as either
passive or mentally active; the former was associated with
lower physical activity levels, while the latter was associated
with higher physical activity levels.
Understanding the different effects of these types of
sedentary activities is critical but is difficult to do using
quantitative data. To our knowledge, few qualitative studies have been conducted on the issue of sedentary time in
older adults. These studies have primarily focused on the
accuracy of self-reported sedentary time and reactions to
sedentary reduction strategies or interventions (Chastin,
Fitzpatrick, Andrews, & DiCroce, 2014; GreenwoodHickman, Renz, & Rosenberg, 2015; Matei et al., 2015;
van Uffelen, Heesch, Hill, & Brown, 2011). Of note, two
of these studies found that the participants enjoyed their
seated activities and did not view them to be unhealthy
(Chastin et al., 2014; Greenwood-Hickman et al., 2015).
Older adults spend more than 8 h per day being sedentary despite clear evidence that sedentary activities have
a negative impact on physical health. Understanding why
older adults continue to engage in such activities is imperative for creation of effective evidence-informed sedentary
time reduction strategies. The purpose of this study, therefore, was to engage in a conversation with older adults to
better understand their perceptions of sedentary behavior
as it pertained to them and their peers.
Methods
Study Design and Method
The research method used to frame this study was phenomenology; a method used to understand what participants
have experienced and how they experience it (Creswell,
Hanson, Plano Clark, & Morales, 2007). Focus groups are
used for “obtaining access to people’s experiences, attitudes
and views” (Hyden & Bulow, 2003) and are used when
current knowledge about a phenomenon is inadequate and
expansion of the literature is important (Powell & Single,
1996); such as the present study. To ensure appropriate reporting of the methods and data, the Consolidated
Criteria for Reporting Qualitative Research was used
(Tong, Sainsbury, & Craig, 2007).
Participants
Community-dwelling older adults from four sites of a senior citizen’s centre in a mid-sized city in southern Ontario
agreed to participate. Each site identified groups that
regularly engaged in an activity or class that was seated
in nature; participants came from groups who played
Rumoli, Canasta, darts, and who went to theatre together.
Participation in the study was voluntary and thus, participants were self-selected.
Research Team and Reflexivity
The principle researcher is a faculty member at a University
in the city where the research was conducted. She has a PhD
in Kinesiology and Health Sciences and is a researcher in the
area of active ageing. She has published several papers on
the association between sedentary time and health in older
adults. Basic assumptions held by the principle researcher
which informed the current study include: physical inactivity negatively influences health, exercise is associated with
successful aging, physical activity influences all domains of
health (physical, psychological, and social).
The moderator was a PhD student at a different
University from the principle researcher, an Occupational
Therapist, and a researcher in the area of mental health
using qualitative methods. As an Occupational Therapist,
basic assumptions held by the moderator, which have
informed this current study, include: occupation affects
health and well-being, occupation organizes time and
brings structure to living, occupational brings meaning to
life, occupations are idiosyncratic, humans need occupation, and occupations have therapeutic potential.
The assistant moderator was an undergraduate student
conducting a research project under the supervision of the
principle researcher; her assumptions were the same as
those of the principle researcher. Neither of the moderators
had previous experience with research in this content area.
All three researchers are women of visible minority groups. The participants of the study were mainly
Caucasian, and the geographical area is primarily Caucasian
(Statistics Canada, 2009). It was apparent during at least
one focus group that the participants felt uncomfortable
talking about different ethnic groups. However, since the
majority of the participants were women, the gender of the
researchers appeared to make for a more comfortable environment for them to speak in.
After completion of each focus group, the research team
engaged in a debriefing session. Their personal experience
of the focus group and strategies were discussed in order to
inform subsequent sessions.
Relationship With Participants
The researchers and participants had no established relationship prior to the focus groups. At the beginning of each
The Gerontologist, 2016, Vol. 00, No. 00
session, participants were given a brief introduction to the
research team and were informed of the research goals.
Interview Guide
An interview guide was created based on suggestions from
Kvale and Brinkmann (2009) and semistructured questions
were used to guide data collection. The questions in the interview guide were piloted with a single participant meeting
inclusion criteria for this study (i.e., over the age of 60 years),
however, results were not included in the analysis. Of note,
this participant was not a member of the seniors centre from
where all other participants were recruited. The following
questions were included in the interview guide:
1. Describe what sedentary behavior means to you.
2. Describe the pros of the sedentary behaviors in which
you participate.
3. Describe the cons of the sedentary behaviors in which
you participate.
4. What types of programs do you feel may help reduce
sedentary behavior in the community?
Some of the interview questions were reworded after completion of the first focus group as a result of negative feedback. The participants felt insulted as they believed they were
being referred to as sedentary. By making adjustments to the
wording of the questions and the introductory comments,
researchers were able to engage participants in the conversation without upsetting them. The following questions were
then used to guide the remaining three focus groups:
1. Describe what sedentary behavior means to you.
2. Describe the benefits of the sedentary behaviors/activities in which you participate.
3. Describe reasons why you think others do not participate in the sedentary behaviors/activities in which you
participate.
4. What do you feel may help reduce sedentary behavior
in the community?
The moderator asked additional questions during each session for the purposes of prompting participants and for
clarification or elaboration purposes.
Sessions were conducted in December 2014. At each
session, a moderator facilitated the discussion, while an
assistant moderator was primarily responsible for the
audio-recording and making field notes. The principle
researcher attended the first two focus groups only.
Each session began with the moderator defining the situation, briefly explaining the purpose of the interview, the use
of the sound recorder, and providing participants with an
opportunity to ask questions. In addition, participants were
informed in writing and verbally of the voluntary nature of
participation as well as their right to leave the session at any
point without repercussion. All participants provided written
consent and all procedures were approved by the University
of Ontario Institute of Technology Research Ethics Board.
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Questionnaires were provided to participants to complete prior to the discussion. The first collected information on sociodemographic data and the second was the
Physical Activity and Sedentary Behaviour Questionnaire
(Canadian Society for Exercise Physiology, 2013). This
questionnaire obtains information on weekly aerobic and
strengthening exercise as well as sedentary time. These data
were collected to describe the sample.
Sample Size
A total of 26 older adults participated in four focus groups.
One individual at the first focus group chose not to participate in the study but remained in the room throughout the
interview; she remained silent and was not included in any
analyses.
Setting
Data were collected at four different senior centre locations
within a 4-day period. These were locations that the participants were regularly visiting and therefore provided a
comfortable environment.
Data Collection
Audio tapes were transcribed verbatim and reviewed to
ensure accuracy. Since the focus groups were conducted
within 4 days of each other, it was not possible to complete preliminary content analysis of the transcripts before
the next interview was conducted. Field notes were taken
before and during the interview by the assistant moderator. Each focus group interview was roughly 45 min in
length.
Feedback was not solicited from the participants after the
interview transcripts were transcribed and analyzed. Many of
the participants did not have electronic mail and the logistics
of obtaining mailing addresses and mailing feedback back
and forth was complicated due to issues of confidentiality.
To ensure rigor, the methods of reflexivity (described
above), audit trail, and investigator triangulation were used.
The audit trail included maintenance of all data collected,
literature used to inform the study design, documents produced during data analysis, personal notes taken during
focus groups, and copies of the data collection instruments.
For investigator triangulation, two of the researchers independently completed analysis of the focus group transcripts
and all three researchers discussed themes that came about
during analysis.
Data Analysis
Each transcript was initially reviewed by the moderator and
assistant moderator to ensure accuracy; content analysis
was conducted five times each. Directed content analysis as
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described by Hsieh and Shannon (2005) was used. A list of
relevant concepts and terms was compiled based on existing
literature on sedentary behavior and used as initial coding
categories. Data analysis was completed manually by two
members of the research team. Codes were extracted independently by the moderator and assistant moderator from
the transcripts in relation to each of the major areas outlined
by the questions from the interview guide. From there, major
themes were identified for each of the interview questions by
collapsing codes. The research team discussed major themes
and any disagreements were resolved during that time. As
suggested by Miles and Huberman (1994), major themes and
corresponding codes were plotted into a flow chart, which
identified relationships. The flow chart reflected themes identified during content analysis and identified underdeveloped
areas that can be used to inform future research.
Results
Characteristics of the focus group participants are available
in Table 1. The mean age of the sample was 74 ± 8.5 years
with 77% of the participants being women. On average,
the participants self-reported engaging in aerobic physical
activity for 172 min per week (±115) and in strengthening activities on 2 days of the week. Participants also selfreported engaging in 5.6 (±1.0) hours of sedentary time per
day. The types of sedentary activities in which participants
were engaging are outlined in Figure 1.
Several themes and subthemes arose from the focus
group content analysis. These are presented in Table 2 and
described below.
Theme 1: Varied Definition of Sedentary Behavior
The definition of sedentary behavior as it appears in the
literature was provided to all participants prior to the
commencement of each focus group. Despite providing
a definition of sedentary behavior, the data reveal that
there is considerable variability in how the term is perceived. The term sedentary behavior was often discussed
negatively. In addition, when asked to define sedentary
behavior, participants named specific activities to define
the term.
Subtheme: Negative Perceptions of Sedentary Behavior
Participants were asked for their definition of sedentary
behavior. Responses included words such as “doing nothing,” “not moving,” “vegetating,” and “relaxation.” There
were also a number of phrases used, which the research
team perceived as being negative including “going stagnant” and “sitting in a wheelchair doing nothing.”
Subtheme: Use of Activities to Define Sedentary Behavior
Participants often used activities to further define sedentary
behavior. These activities included an array of arts and crafts
such as knitting, crocheting, and Swedish weaving. Activities
involving the use of technology, such as computer use and
watching television, were also listed. Games, whether completed individually or in groups, were used in the description
of sedentary behavior. Examples of games mentioned were
crosswords, word finds, cribbage, and poker. Finally, activities that included a social aspect, such as attending plays and
concerts, singing in a choir, and going to meals with friends,
were used in the participant’s definition of sedentary behavior.
Table 1. Participant Demographics by Focus Group
Characteristic
Group 1 (n = 5)
Group 2 (n = 12)
Group 3 (n = 6)
Group 4 (n = 3)
Total Sample (n = 26)
Age
Gender
Male
Female
Marital status
Single
Married
Divorced or separated
Widow(ed)
Race/ethnicity
Caucasian
Other
Education
Some high school
Completed high school
Some community college
Completed community college
Some university
Completed bachelor degree
Completed masters or PhD
No response
72 ± 5.8
75 ± 7.9
74 ± 11.4
70 ± 11.3
74 ± 8.5
0.0
100.0
33.3
66.7
16.7
83.3
33.3
66.7
0.0
20.0
40.0
40.0
0.0
41.7
8.3
50.0
0.0
16.7
16.7
66.7
0.0
0.0
0.0
100.0
0
26.9
15.4
57.7
80.0
20.0
100.0
0.0
83.3
16.7
100.0
0.0
92.3
7.7
40.0
40.0
20.0
0.0
0.0
0.0
0.0
0.0
25.0
25.0
8.3
8.3
16.7
0.0
0.0
8.0
0.0
33.3
16.7
33.3
0.0
0.0
16.7
0.0
0.0
0.0
33.3
33.3
0.0
33.3
0.0
0.0
19.2
26.9
15.4
15.4
7.7
3.8
3.8
7.7
Note: Data are presented as a percent of the sample except for the variable age (mean ± SD).
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Other
Watching TV
Visiting with others
Reading
Playing muscial instruments
Listening to music
Handicrafts
Crosswords, etc
Computer activities
Bingo,cards, or other games
0
20
40
60
80
100
Percent of sample
Figure 1. Sedentary activities that participants self-reported engaging in the past 7 days.
Table 2. Themes and Subthemes Identified From Focus Groups
Areas probed
Theme
Subtheme
Definition of sedentary behavior
Definition of sedentary behavior
varied
Benefits of sedentary behavior
Perceived benefits
Disadvantage of sedentary
behavior
Barriers to participation
Perceived disadvantages
• Negative perceptions of the term “sedentary behavior”
• Use of activities to define “sedentary behavior”
• Personal identification with “sedentary behavior”
• Social benefits
• Cognitive benefits
• Physical benefits
• Meaningful activities
• Impact on physical health
Recommendations
Increasing participation
Real barriers to participation
Theme 2: Perceived Benefits of Sedentary
Activities
Focus groups provided rich discussions around the perceived benefits of engaging in sedentary activities of their
choosing. The benefits discussed can be grouped as being
social, cognitive, or physical.
Subtheme: Social Benefits
The theme of social benefits of sedentary behaviors was
common among all participants. Many identified themselves as being widowed and living on their own. As a
result, they sought out companionship by joining the local
senior’s centre in order to connect socially with others.
P1: “It’s the only game I, I took to is Canasta, I like it”
P2: “I enjoy it. I use to play it years ago. Like I mean…
probably before you were born. And I come in here one
day, and say I would love to start playing again. But
I said I haven’t played for so long. I use to join in, and
• Person factors
• Environmental factors
• Stigma
• Organizational supports
I have, - other than when I’ve been sick or had things to
do, I’ve been here coming almost three years now. And
I love it! The main thing is, the friendship.”
The social benefits were also discussed in the context of
transitioning through life stages from full-time paid employment to being retired. Many of the participants described
how their preferred sedentary behaviors provided them
opportunities to meet new people.
Investigator: “What are the benefits of some of these sitting activities that you are, are doing?”
P1: You keep your mind active”
P2: “Yeah”
P3: “And friendship. Friendship is one of them… and we
all get along”
P1: “That’s why we’re all here”
P2: “And this is… This is one of the finest bunch that
you could find, and I mean it. I tell you that.”
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P4: “At least we could come out and have companionship instead of being home alone”
indicated that they integrate physical aspects to their sedentary activities.
One participant viewed social engagement with others as a
means of “preparing for the future.”
I play Ramoli. I always, when I put my stuff on the
thing…. I always get up and do it. So I’m up every few
minutes instead of sitting, you know I always get up.
Which is a good thing I think.
[T]here’s also the part whereas I’m ageing. I mean, my
husband is ageing too. So... I mean... I don’t know who
is gonna go first, who’s gonna go last, I got no children
at home. So, and my husband has different ideas than
I do, so he doesn’t…do…involve himself in the seniors,
where I do, and I feel like I am benefiting more than
he is, because… if anything should happen, I have my
companionships here.
The social aspect of the participants’ sedentary activities
appeared to be important for kinship and for support
through life transitions as well.
Subtheme: Cognitive Benefits
The cognitive benefits of the participants’ chosen sedentary
activities often came about through the discussion of the
definition of sedentary behavior. The participants would
describe aspects of their cognitive functioning and how
they were enhanced through engaging in various activities.
P1: Like knitting, sewing, you’re counting a lot.
Mentally when you’re playing games, your stimulating your brains. So… I mean, its keeping us mentally
healthy longer.
P2: And there’s stimulation with all…they put on, also
mental, like myself personally, I am involved with the computers at the moment, learning more about computers.
Subtheme: Physical Benefits
Regardless of the definition of sedentary behavior provided
to each of the focus groups, the participants did identify
their chosen sedentary activities as having physical benefits.
Participants perceived the act of joining sedentary activities
within the local senior’s centre as having aspects that were
physically demanding in nature.
I mean generally speaking, when you’re talking about
seniors, I think even just, you know, they don’t have to
be physically like running and doing all of that stuff.
But even when you’re, when you ask, when you have a
senior come in to a center like this, that… They’re getting outta bed, they have to get dressed, they have to
either you know, um… Walk or take a bus or get a taxi
or get a ride or something. They gotta walk through the
parking lot and walk in, you know…. We’ve had people huffing and puffing by the time they get in here with
their walkers, but I mean, that’s, that’s already more
exercise than they would have had sitting at home.
In addition to the physical demands related to the task of
attending activities at the senior’s centre, many participants
Subtheme: Meaningful Activities
The discussion in the focus groups around the benefits of
sedentary activities also touched on the benefit of engaging
in activities. A number of the participants indicated that
having activities, regardless of the activity itself, provided
them with meaning and structure in their daily life. One
participant stated that the activities “gives me a reason to
get out of bed in the mornings.” Another indicated that
after the passing of her husband, she needed to find a way
to “fill in [my] time.”
Theme 3: Perceived Disadvantages of Sedentary
Behavior
The interview guide initially indicated that this discussion would be facilitated with the question, “Describe
the cons of the sedentary behaviors in which you participate?” The use of this question in the first focus
group elicited responses that included “if we did we’d
quit them” and “the thing is, that we choose what we
want to do.” As a result of these responses, the question was modified as described in the interview guide.
The only disadvantage of sedentary behavior identified
by the focus groups was the impact these activities have
on physical health.
Subtheme: Impact on Physical Health
Some participants indicated that sitting for extended periods of time was associated with joint stiffness, thus making
it more difficult to get up from a seated position. One participant remarked that she would also fall asleep if she sat
too long, so she felt the need to get up periodically. There
was a clear relationship between the physical limitations
of individuals that prevented them from engaging in more
active tasks. This relationship appeared connected with
physical changes due to age.
P1: [I am] physically active. So I think all of the seniors
are trying to stay in this bracket, the younger ones like
myself, but when we get to the older stage, we know,
that we won’t be able to do these functions that I’m
doing now. I won’t be able to.
P2: It’s ageing…Yeah, you just get to the point where
you can’t do it…I use to do a lot more things but now…
you know…. now you just can’t do it…The joints give
out!...You can only push yourself so far…maybe we
don’t do as….as much or in duration like exercising.
Maybe we’re not doing in the duration that we use to.
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Theme 4: Barriers to Participation
The question pertaining to barriers was also modified, as
described in the interview guide section, to ask about barriers that “others” may perceive. Participants identified a
number of barriers, which have been organized as person
factors and environmental factors.
Subtheme: Person Factors
Physical limitations and motivation were identified as barriers to engaging in community-based activities. Physical
limitations in combination with weather contribute to the
ability of older adults to participate:
P1: And not everyone can do that. Umm…uh…you
know just physically, I think some people have difficulty
moving around and it’s too much trouble and then winter time, you know, it cuts out a lot of people. Because
you know, as soon as the snow comes out, even all activities here. When you got a bad whether day, you know,
all of a sudden the attendance is down because if they
have to wait for a…a bus. You know, an older person
waiting for a bus is just not good. You don’t wanna slip
and fall and hurt yourself. It’s not that easy to get up
again, you know.
Given the age of the participants and their peers, the overall health and well-being of individuals was identified as a
challenge; however, it was personal motivation that elicited
a great deal of discussion among all the groups. Some individuals who did not participate in community based activities were perceived as being “lazy” and that “they want it
passed onto them, … they want somebody to guide them
and, and lead... A lot of people are like that.”
Other participants attribute the lack of motivation to participate as part of who the individual is:
When they retire or when they’re older, they’re not
going to do it.
They don’t want to leave their little cozy place, you
know. You know…
I don’t think no matter how much you try to get them
out, they’re not gonna do it.
Motivation was also closely linked to the stigma people
held about ageing:
P1: I think the ‘senior citizens’ part scares a lot of people
away. I’ve often said, it should be just, fifty-five plus club.
That way it doesn’t, or, you know, [maybe] Zoomers
club, you know? Whatever it is because Senior Citizens,
it just… It just means old. It really does…Like I would
prefer just something like a… you know, club fifty-five
sounds good. It sounds like a trendy place to go.
P2: I think some people…. Um…like consider themselves too ‘uppidity’, for lack of a better word. I think
some people think they’re too ‘uppidity’ to come to a
place like this. They, they really do. Like they’re retired...
7
P1: Well they say ‘Oh it’s for old people! It’s for old people. Too many old people.”
P2: And they… Yeah… That’s sort of the attitude. ‘Well
it’s for old people’.
Subtheme: Environmental Factors
A number of environmental factors were identified in the
focus groups as impacting the participation of others in
community-based activities. The issue of cultural differences dominated one of the focus groups and was indicated
as a significant barrier for engaging people of different ethnic and cultural backgrounds:
P1: “I mean a lot of the seniors come over to Canada
and then don’t speak English, read English.
P2: “Oh no, no, no!”
P1: “That, I’ve got nothing against that”
P2: “No”
P1: “But that doesn’t… encourage them or even give them
any…. feeling that they want to move, they want to…”
Another environmental factor that was discussed was lack
of resources to support accessing services including lack of
transportation and the need for ongoing subsidies for seniors programs.
So I think um… getting here would be you know, transportation for, for older people is, is…is more difficult.
Discussion
The purpose of this research was to better understand the
perceptions of sedentary behavior among socially engaged
older adults. Perceptions on terminology, activities, barriers, and more were sought to shed light on the issue of
sedentary behavior within a population known to have
the highest sedentary time in Canada. Using focus group
methodology, semistructured questions were used to guide
data collection. Analysis of each transcript revealed various
themes and subthemes.
The most striking finding was that there was an aversion
to the term sedentary behavior among focus group participants. This is something that has not been documented in
the literature to date. Participants viewed the term “sedentary” as negative, as it was perceived to be associated with
poor health, negative attitudes, and stereotypes associated
with older age. Despite aversion to the term, participants
knowingly engaged in many sedentary activities but perceived those activities to be positive, rather than negative.
The term sedentary behavior has become popular in the
past decade with hundreds of new research publications and
extensive media coverage on the topic. Media headlines are
often quite dramatic and highlight the negative health consequences of sedentary behaviors. Thus, it is not surprising
that participants in our study perceived the term to be negative. What was surprising is that despite agreeing that their
activities were indeed “sedentary” in nature, they did not
8
identify with the term. This was likely because the participants were socially engaged and felt that the seated activities in which they engaged were not negative as they offered
many social and cognitive benefits. A possible explanation
for this comes from applied psychology on group identity
and from research on ageing stereotypes. The notion that
group identity influences health and well-being was synthesized by Haslam, Jetten, Postmes, and Haslam (2009). The
authors noted that based on Social Identity Theory, belonging to a group perceived to be inferior can threaten wellbeing. The reaction of our participants aligns with this, as
they did not want to be associated with a group that had
negative connotations to their lifestyle and health.
Similarly, older adults are often perceived to be tired,
sick, lonely, or depressed, thus creating negative expectations
regarding ageing and negative ageing attitudes. Being associated with the term sedentary would positively reinforce such
stereotypes. A study conducted by Sarkisian, Steers, Hays,
and Mangione (2005) found that older adults with lower
expectations regarding ageing reported lower levels of physical activity than those with higher expectations. Many older
adults consider a decline in health as a natural part of ageing,
however older adults with poor health-related quality of life
tend to experience more negative thoughts of ageing. These
thoughts are internalized and are expressed in later years, as
negative beliefs are associated with negative health outcomes
(Levy, Slade, Kunkel, & Kasl, 2002; Rakowski & Hickey,
1992; Sarkisian et al., 2005). It is possible that because our
participants were socially engaged and perceived themselves
to be healthy, that is, had positive ageing expectations, they
did not identify with the term sedentary.
Despite the diverse range of negative health consequences
of sedentary behavior documented in many research studies,
the participants felt that there were several benefits to participating in their seated activities. The seated activities were
thought to be meaningful and provided social interaction
and mental stimulation. This is consistent with findings from
qualitative work by Chastin and colleagues (2014) who
interviewed older adults in Scotland and noted that many
participants refused to decrease their sedentary time. This
was primarily due to physical constraints, but also because
the older women interviewed did not perceive their activities
to be unhealthy, but rather viewed them as a way to cope
and remain functionally independent. Such positive findings
are not out of the norm. In fact, several studies have shown
that there are many benefits to seated activities (Basak
et al., 2008; Bleakley et al., 2015; de Rezende et al., 2014;
Nimrod, 2010; O’Neil & Dogra, 2015; Phelan et al., 2004).
For example, social interaction obtained through seated
activities has been shown to positively influence social health
among older adults (Park, 2009). A recent study by O’Neil
and Dogra (2015) found a consistent and positive association between sedentary activities and self-reported health
outcomes among middle-aged and older men and women.
While the participants in this study were spending a large
portion of their waking hours being sedentary, they were
The Gerontologist, 2016, Vol. 00, No. 00
also engaging in physical activities. In fact, many were participating in regular exercise classes. Of those who were not,
they were still physically active due to active transportation,
household chores, and other activities. Despite the active
nature of our participants, these participants found that
their chronic conditions and musculoskeletal pain limited
their ability to get up often or stand for long periods of time.
Nevertheless, the participants agreed that there were negative consequences to sitting for extended periods of time. For
example, they said that they felt stiff and immobile, which
was a great disadvantage of the seated activities. They also
expressed that prolonged seated activities are well known
to cause their joints to stiffen and make them feel sleepy.
However, they commented that getting up often was not
an easy task. Thus, the current recommendation that adults
stand every hour would not be feasible in this population.
The participants also listed a number of barriers to
reducing sedentary time. The barriers were either person or environment factors, similar to those noted in the
physical activity literature (Schutzer & Graves, 2004), and
those noted by Chastin and colleagues (2014). What was
interesting about this part of the conversation was that the
participants mostly spoke about their peers who were not
engaged with activities in the community instead of themselves. This likely relates back to identifying with the term
and issues around ageing stereotypes.
Two barriers worth further address were transportation and cultural background. The first is not a surprising
barrier, but perhaps one with unique implications in this
population. Older adults are often unable to drive or do
not have a car for a variety of health and socioeconomic
reasons. As such, they rely heavily on public transit in
order to get to seniors centers where they engage in physical and recreational activities. As noted by the participants,
this can be challenging when the weather is bad or from
certain geographical areas where public transit is not well
connected. Thus, in congruence with Owen and colleagues
(2011) model, the built environment is of importance for
several reasons. For example, the sidewalks to get to the
bus stop must be clear and ploughed, the buses must be
accessible for those with gait aids or wheelchairs, the senior
or community centers should be on major bus routes, and
should perhaps offer their own form of transportation. In
fact, a recently published scoping review of recreation in
older adults found that proximity to facilities and transportation are critical to ensure uptake (Levasseur et al., 2015).
Ensuring the appropriate built environment may further
promote active lifestyles and sedentary time reduction in
those currently unable to access recreational facilities.
Another interesting barrier that came up was cultural background. Our sample was primarily Caucasian older women.
They perceived cultural background as a barrier to participation in community recreation activities. Research among
Canadian adults indicates that compared to Caucasians,
ethnic Canadians are less active (Bryan, Tremblay, Pérez,
Ardern, & Katzmarzyk, 2006; Dogra, Meisner, & Ardern,
The Gerontologist, 2016, Vol. 00, No. 00
2010). However, further research is required to better understand the reasons for this and if this trend persists among
older adults of different ethnic backgrounds.
Strengths of this study include the large sample size for
focus group methodology and the lack of bias of the two
researchers leading and assisting with the focus groups.
There are also some limitations of the present study worth
highlighting. First, the participants of this study were
socially engaged within the community, thereby decreasing
the generalizability of this study to individuals who are perhaps more isolated due to their health and sedentary lifestyle. The socially engaged group was deliberately chosen
due to ease of access. Future research should consider ways
to engage more sedentary groups of older adults. Second,
the majority of the participants were Caucasian females.
Future research should assess differences between men and
women, as well as between older adults of different ethnic
backgrounds. Third, because participants were upset by use
of the term sedentary, some participants did not speak or
engage as openly as others. Finally, we used self-reported
measures of physical activity and sedentary time to characterize the sample. Future research should use objectively
measured data to better understand the quantity and quality of activities older adults are engaging in.
The findings from the present study are the first to describe
a distaste towards the term “sedentary” among older adults
and also highlight significant differences in sedentary behavior perceptions of older adults in our society. These findings
have important implications for public health messages and
sedentary behavior reduction strategies. For example, use
of traditional terminology to address this issue may alienate the very population being targeted. Participants in our
study were sedentary, however, did not identify with the term.
Thus, while creation of sedentary behavior guidelines is critical for this cohort, terms used to create the guidelines will
significantly impact uptake and adherence. It is also clear
from this study that while older adults understand that there
are physical consequences to engaging in sedentary behavior, they perceive many benefits to such activities as well. As
such, sedentary time reduction strategies targeting this cohort
may need to focus on integrating activity into sedentary
tasks rather than eliminating sedentary activities completely.
Participants felt that there were many social and cognitive
benefits to the activities they engaged in, and that this provided meaning in their lives. Eliminating such activities would
significantly impact the health and quality of life of older
adults. Finally, participants recognized that they had physical limitations and that this impacted their ability to reduce
sedentary time. Current recommendations suggest sitting for
less than 2 h per day and breaking up sedentary time as often
as possible. It appears that this may be unrealistic for this age
group. Evidence-informed guidelines and sedentary reduction
interventions targeting this cohort must consider the practicality of recommendations to ensure appropriate uptake and
long-term adherence. In fact, qualitative research obtaining
feedback on sedentary reduction interventions has shown
9
that older adult’s enjoyment of sedentary activities, the built
environment, fear of embarrassment, and energy levels are
barriers to reducing sedentary time, despite viewing interventions positively (Greenwood-Hickman et al., 2015).
In conclusion, socially engaged older adults who selfreport being sedentary (for an average of 5.6 h/day) do
not identify with the term sedentary and perceive it to be
negative. Further, older adults perceive many benefits to
sedentary activities, particularly pertaining to psychosocial
health. These novel findings have implications for public health strategies. Future research should consider the
unique aspects of sedentary time in older adults to ensure
sedentary time is appropriately reduced.
Funding
This work was supported by internal funds (competitive) from
University of Ontario Institute of Technology (UOIT).
Acknowledgment
None of the authors have any conflicts to declare.
References
Asztalos, M., Cardon, G., De Bourdeaudhuij, I., & DeCocker, K.
(2015). Cross-sectional associations between sitting time and
several aspects of mental health in Belgian adults. Journal of
Physical Activity and Health, 12, 1112–1118. doi:10.1123/
jpah.2013-0513
Basak, C., Boot, W. R., Voss, M. W., & Kramer, A. F. (2008). Can
training in a real-time strategy video game attenuate cognitive
decline in older adults? Psychology and Aging, 23, 765–777.
doi:10.1037/a0013494
Bleakley, C. M., Charles, D., Porter-Armstrong, A., McNeill, M.
D. J., McDonough, S. M., & McCormack, B. (2015). Gaming
for health: A systematic review of the physical and cognitive effects of interactive computer games in older adults.
Journal of Applied Gerontology, 34, NP166– NP189.
doi:10.1177/0733464812470747
Bryan, S. N., Tremblay, M. S., Pérez, C. E., Ardern, C. I., &
Katzmarzyk, P. T. (2006). Physical activity and ethnicity:
Evidence from the Canadian Community Health Survey.
Canadian Journal of Public Health, 97, 271–276.
Canadian Society for Exercise Physiology. (2013). Physical activity
training for health (1st ed). Ottawa, Canada: CSEP.
Chastin, S. F. M., Fitzpatrick, N., Andrews, M., & DiCroce, N. (2014).
Determinants of sedentary behavior, motivation, barriers and
strategies to reduce sitting time in older women: A qualitative
investigation. International Journal of Environmental Research
and Public Health, 11, 773–791. doi:10.3390/ijerph110100773
Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A.,
Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009).
Exercise and physical activity for older adults. Medicine &
Science in Sports & Exercise, 41, 1510–1530. doi:10.1249/
MSS.0b013e3181a0c95c
Copeland, J. L., Clarke, J., & Dogra, S. (2015). Objectively measured and self-reported sedentary time in older Canadians.
10
Preventive Medicine Reports, 2, 90–95. doi:10.1016/j.
pmedr.2015.01.003
Creswell, J. W., Hanson, W. E., Plano Clark, V. L., & Morales, A.
(2007). Qualitative research designs: Selection and implementation. The Counseling Psychologist, 35, 236–264.
doi:10.1177/0011000006287390
de Rezende, L. F. M. D., Rey-Lopez, J. P., Matsudo, V. K. R., & Luiz,
O. D. C. (2014). Sedentary behavior and health outcomes among
older adults: A systematic review. BMC Public Health, 14, 333.
doi:10.1186/1471-2458-14-333
Dogra, S., Meisner, B. A., & Ardern, C. I. (2010). Variation in mode of
physical activity by ethnicity and time since immigration: A crosssectional analysis. International Journal of Behavioral Nutrition
and Physical Activity, 7, 75. doi:10.1186/1479-5868-7-75
Dogra, S., & Stathokostas, L. (2012). Sedentary behavior and physical activity are independent predictors of successful aging in
middle-aged and older adults. Journal of Aging Research, 2012.
doi:10.1155/2012/190654
Greenwood-Hickman, M. A., Renz, A., & Rosenberg, D. E. (2015).
Motivators and barriers to reducing sedentary behavior among
overweight and obese older adults. Gerontologist. doi:10.1093/
geront/gnu163
Harvey, J. A., Chastin, S. F. M., & Skelton, D. A. (2013). Prevalence
of sedentary behavior in older adults: A systematic review.
International Journal of Environmental Research and Public
Health, 10, 6645–6661. doi:10.3390/ijerph10126645
Haslam, S. A., Jetten, J., Postmes, T., & Haslam, C. (2009). Social
identity, health and well-being: An emerging agenda for applied
psychology. Applied Psychology: An International Review, 58,
1–23. doi:10.1111/j.1464-0597.2008.00379.x
Hsieh, H. F., & Shannon, S. E. Three approaches to qualitative content analysis. Qualitative Health Research, 2005, 15, 1277–
1288. doi:10.1177/1049732305276687
Hyden, L-C., & Bulow, P. H. (2003). Who’s talking: Drawing conclusions from focus groups- some methodological considerations.
International Journal of Social Research Methodology, 6, 305–
321. doi:10.1080/13645570210124865
Kikuchi, H., Inoue, S., Sugiyama, T., Owen, N., Oka, K., Nakaya,
T., & Shimomitsu, T. (2014). Distinct associations of different sedentary behaviors with health-related attributes among
older adults. Preventive Medicine, 67, 335–339. doi:10.1016/j.
ypmed.2014.08.011
Kvale, S., & Brinkmann, S. (2009). Interviews: Learning the craft
of qualitative research interviewing (2nd ed.). Los Angeles: Sage
Publications.
Levasseur, M., Généreux, M., Bruneau, J. F., Vanasse, A., Chabot, É.,
Beaulac, C., & Bédard, M. M. (2015). Importance of proximity
to resources, social support, transportation and neighborhood
security for mobility and social participation in older adults:
Results from a scoping study. BMC Public Health, 15, 503.
doi:10.1186/s12889-015-1824-0
Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002).
Longevity increased by positive self-perceptions of aging. Journal
of Personality and Social Psychology, 83, 261–270.
Liffiton, J. A., Horton, S., Baker, J., & Weir, P. L. (2012). Successful
aging: How does physical activity influence engagement with life?
European Review of Aging and Physical Activity, 9, 103–108.
Matei, R., Thuné-Boyle, I., Hamer, M., Iliffe, S., Fox, K. R., Jefferis,
B. J., & Gardner, B. (2015). Acceptability of a theory-based
The Gerontologist, 2016, Vol. 00, No. 00
sedentary behaviour reduction intervention for older adults (‘On
Your Feet to Earn Your Seat’). BMC Public Health, 15, 606.
doi:10.1186/s12889-015-1921-0
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis
an expanded sourcebook. Thousand Oaks, CA: SAGE.
Nimrod, G. (2010). Seniors’ online communities: A quantitative
content analysis. The Gerontologist, 50, 382–392. doi:10.1093/
geront/gnp141
O’Neil, C., & Dogra, S. (2015). Different types of sedentary activities and their associations with perceived health and wellness
among middle-aged and older adults: A cross-sectional analysis. American Journal of Health Promotion. doi:10.4278/
ajhp.140714-QUAN-332R1
Owen, N., Sparling, P., Healy, G., Dunstan, D., & Matthews, C. (2010).
Sedentary behavior: Emerging evidence for a new health risk. Mayo
Clinic Proceedings, 85, 1138–1141. doi:10.4065/mcp.2010.0444
Owen, N., Sugiyama, T., Eakin, E. E., Gardiner, P. A., Tremblay, M.
S., & Sallis, J. F. (2011). Adults’ sedentary behavior determinants
and interventions. American Journal of Preventative Medicine,
41, 189–196. doi:10.1016/j.amepre.2011.05.013
Park, N. S. (2009). The relationship of social engagement to
psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28, 461–481.
doi:10.1177/0733464808328606
Phelan, E. A., LaCroix, A. Z., & Larson, E. B. (2004). Older adults’ views
of successful aging: How do they compare with researchers’ definitions? Journal of the American Geriatrics Society, 52, 211–216.
Powell, R. A., & Single, H. M. (1996). Focus groups. International
Journal or Quality in Health Care, 8, 499–504.
Rakowski, W., & Hickey, T. (1992). Mortality and the attribution of
health problems to aging among older adults. American Journal
of Public Health, 82, 1139–1141.
Sarkisian, C. A., Steers, W. N., Hays, R. D., & Mangione, C. M.
(2005). Development of the 12-item expectations regarding
aging survey. The Gerontologist, 45, 240–248.
Schutzer, K. A., & Graves, B. S. (2004). Barriers and motivations to exercise in older adults. Preventive Medicine, 39,
1056–1061.
Statistics Canada. (2009). Population by selected ethnic origins, by
census metropolitan areas (2006 Census) (Oshawa, Toronto).
Retrieved from http://www.statcan.gc.ca/tables-tableaux/sumsom/l01/cst01/demo27g-eng.htm
Swift, D. L., Lavie, C. J., Johannsen, N. M., Arena, R., Earnest,
C. P., O’Keefe, J. H., … Church, T. S. (2013). Physical activity, cardiorespiratory fitness, and exercise training in primary
and secondary coronary prevention. Circulation Journal, 77,
281–292.
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for
reporting qualitative research (COREQ): A 32-item checklist for
interviews and focus groups. International Journal for Quality
of Health Care, 19, 349–357.
Tremblay, M. S., Colley, R. C., Saunders, T. J., Healy, G. N., & Owen,
N. (2010). Physiological and health implications of a sedentary
lifestyle. Applied Physiology, Nutrition, and Metabolism, 35,
725–740. doi:10.1139/H10-079
van Uffelen, J. G., Heesch, K. C., Hill, R. L., & Brown, W. J. (2011).
A qualitative study of older adults’ responses to sitting-time
questions: Do we get the information we want? BMC Public
Health, 11, 458. doi:10.1186/1471-2458-11-458