QUEST, 2005, 57, 46-66
© 2005 National Association for Kinesiology and Physical Education in Higher Education
Movement and Mobility Influence
on Successful Aging:
Addressing the Issue of
Low Physical Activity
Roberta E. Rikli
Demographic projections indicate that the over 65 population will double
between 2000 and 2030, from 35 million to 70 million. Unfortunately,
statistics also show that although people are living longer, they are living
with an increased prevalence of chronic disease, a trend that could have
devastating effects on health care costs and quality of life in later years unless
ways are found to reverse this trend. This paper briefly reviews evidence
showing the positive contributions of regular physical activity (PA) to health
and well-being in later years, as well as the role of PA in preventing and, in
some cases, reversing age-related functional declines. However, despite the
well-documented benefits of PA, two-thirds of Americans continue to live
mostly sedentary lifestyles, a statistic that has been largely unaffected by past
physical activity intervention research. Issues related to this persistent lack of
physical activity are discussed.
The dramatic growth projections in the older adult population throughout most
of the world has important implications for just about everyone, but especially for
researchers, health care providers, policy makers and others interested in addressing
the high cost of disease, disability, and reduced quality of life often associated
with aging. In the United States, the over 65 population is expected to more than
double between 2000 and 2030, from 35 million to 70 million (National Center for
Health Statistics, 2004). Unfortunately, data also show that although Americans are
living longer (with the over 85 population being the fastest growing of all), they
are not necessarily living healthier lives. Even though there has been a decline in
disease-related death rates (especially those caused by heart disease), there has
actually been an increase in the percent of older Americans living with chronic
The author is with the College of Human Development and Community Service at
California State University, Fullerton. E-mail: [email protected].
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illnesses, including heart disease. Between 1984 and 1995, there was an increased
prevalence of stroke, diabetes, cancer, arthritis, and heart disease in both men and
women over the age of 70 (Older Americans, 2000).
Not surprisingly, older people’s self-reported rating of their health, perhaps
the most important health measure of all, has followed a similar pattern, at least
for the rapidly growing and vulnerable over 85 population. In 1982, 36% of those
over 85 years of age rated their health as very good or excellent compared with only
31% in 1999, according to statistics from the National Health Interview Survey
(Older Americans, 2000). As life expectancy continues to increase, so too does
the likelihood of living more years with disease and poor health, unless ways are
found to reduce chronic disease.
Statistics showing a decline in health are especially troublesome when
considering that good health and physical independence are “quality of life” goals
and markers of “successful aging” for individuals, as well as for society as a whole.
The major components of successful aging according to Rowe and Kahn (1998),
well-known gerontologists and leaders of the MacArthur Foundation Studies of
Successful Aging in America, have been defined as having:
1. Low probability of disease/disability
2. High cognitive and physical capacity
3. Active engagement in life
Others, such as proponents of the new and increasingly popular positive psychology
movement have suggested that “good health” is usually judged to be the single most
important domain of people’s lives, with self-rated “subjective health” being even
more important to life satisfaction than objective health (Seligman, 2002).1
The increased prevalence in chronic disease is also troublesome as well as
unfortunate considering that as much as 70% of the health decline associated with
aging is thought to be modifiable through proper attention to relevant lifestyle
behaviors such as physical activity and healthy nutritional habits (National Center
for Chronic Disease Prevention and Health Promotion, 1999). Because of the
importance of good health to quality of life in later years, and because of the need
to control the spiraling health care costs associated with the growing population
of older adults, it is extremely important to carefully examine the factors that are
influencing the health and functional ability of this population.
In this paper I will first comment on the particular role that movement
(physical activity) has on maintaining health and mobility during the aging process.
I will then make some observations on a related and more urgent topic, that of
the physical inactivity epidemic that continues to plague most of the developed
countries of the world. It is this topic that would appear to be “what matters
most” at this stage of our physical activity research. Unfortunately, despite strong
evidence showing the lifelong health and functional benefits of regular participation
in moderate physical activity, very few adults (less than a third) get the amount of
exercise they need to realize these benefits (Physical Activity and Older Americans,
2002). Although increasing physical activity participation has been a major goal
of several national initiatives (e.g., the Healthy People 2000 and 2010 initiatives;
the National Blueprint, etc.), little change in physical activity patterns has been
observed across any age group (Healthy People, 2004). Perhaps the inactivity-
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related consequences of improved technology, automation, and increased time spent
in highly sedentary activities (e-mail, internet, TV, movies, and video games) are
offsetting any positive effects of public health messages and other motivational
strategies that have been designed to increase participation in physical activity.
Because of the persistent, disappointing statistics regarding the predominance of
physically inactive lifestyles, it would seem almost inexcusable to focus solely
on the positive influences of physical activity on successful aging, without also
addressing the lack of participation factor.
Physical Activity (Movement) Effects on the Aging Process
Although, admittedly, there can be some risk associated with physically
active lifestyles (mainly due to musculoskeletal injuries), the preponderance of
evidence over many years has shown that the benefits far outweigh the risks. Below
is a summary of evidence providing support for (a) the general health benefits of
physical activity across the life span, (b) the role of physical activity in reducing
functional declines in later years, and (c) the role of physical activity and exercise
in reversing age-related declines.
General Health Benefits of Physical Activity
Across the Lifespan
Both experiential and experimental evidence provide strong support for
the overall value of physical activity during the aging process. As long ago as
400 B.C., Hippocrates (quoted in Withington, 1927, p. 339) made the following
observation:
Speaking generally, all parts of the body which have a function,
if used in moderation and exercised in labours to which each is
accustomed, become thereby healthy and well developed, and
age slowly; but if unused and left idle, they become liable to
disease, defective in growth, and age quickly.
Interestingly, little has changed over the past 2,400 years relative to this
basic, historic message, except that there now exists scientific evidence to confirm
the observations made by Hippocrates—i.e., that physical activity of moderate
intensity contributes to lifelong well-being and can extend the healthy lifespan of
older adults for many years.
Similar summary statements describing the health benefits of physical
activity have been widely published and are supported by almost every major
health and fitness organization in the country. These include the American College
of Sports Medicine (ACSM), the American Heart Association (AHA), the Centers
for Disease Control (CDC), the President’s Council for Physical Fitness and Sport,
The National Institute for Health, and the National Institute for Aging, to name
just a few (ACSM, 1998; Pate et al., 1995; U.S. Department of Health and Human
Services, USDHHS, 1996, 2000).
In addition, papers and proceedings from numerous national and international
physical activity and health conferences have provided scientific evidence
confirming the positive overall effects of physical activity on lifelong health and
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well-being. Examples of such conferences include the International Consensus
Conferences on the topics of physical activity, fitness, and health held in Toronto
in 1966, 1988, and 1992 (Bouchard, Shephard, Stephens, Sutton, & McPherson,
1990; Bouchard, Shephard, & Stephens, 1994), the World Congresses on Physical
Activity and Aging held every four years since 1984, and numerous other specialty
conferences such as the recent National Blueprint Consensus Conference (Shephard
et al., 2003). Also, as many will recall, Physical Activity and Aging was the theme
of the 1988 American Academy of Physical Education meeting, which led to a
landmark publication at the time—The Academy Papers: Physical Activity and
Aging (Spirduso & Eckert,1989) and also was the theme of the 1999 Academy
meeting in Vail, Colorado. Sample statements from speakers at these conferences
include the following:
. . . there are enough data to now suggest that exercise promotes
psychological and physical well-being in elderly. (Berger, 1989,
p. 54)
Physical activity may be one of the most powerful interventions
currently available for combating the deterioration in functional
capacity that occurs with the aging of the central nervous system.
(MacRae, 1989, p. 74)
There is now compelling evidence that physical activity is
associated with significant physiological, psychological, and
social benefits in older adult populations. (Chodzko-Zajko,
2000, p. 333)
Clearly, scientific consensus has been reached regarding the positive
contributions of physical activity (movement) to successful aging, with the current
predominant public health message being that people of all ages should accumulate
30 min or more of moderate-intensity physical activity on most, preferably all days
of the week (Pate et al., 1995; USDHHS, 2000).
More specifically, the well-known benefits of participating in regular
physical activity of at least moderate intensity on five or more days of the week
include reduced risk of developing chronic diseases (e.g., coronary heart disease,
diabetes, obesity, high blood pressure, and some types of cancer); protection against
premature death; improved psychological well-being; improved health of bones,
muscles, and joints; and improved functional ability and reduced risk of falls in
older adults (USDHHS, 1996, 2000).
Role of Physical Activity in Reducing
Declines in Functional Ability
Data suggest that the usual decline in physical function after age 50 is about
10-15% per decade, or about 1-1.5% per year. This decline has been observed in
lower body strength (ACSM, 1998; Shephard, 1997; Vandervoort, 1992; White,
1995), upper body strength (Aniansson, Hedberg, Henning, & Grimby, 1986;
Grimby, Danneskold-Samsoe, Hvid, & Salatin, 1982; Shephard, 1997), and in
aerobic endurance as indicated by maximal oxygen uptake (ACSM, 1998; Frontera
& Evans, 1986; Hagberg, 1994).
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Similar patterns of decline were observed in field-based functional ability
tests in a nationwide study of over 7,000 older adults between the ages of 60 and 94
(Rikli & Jones, 1999b). This study was conducted to establish normative functional
performance scores for the general population of community-residing older adults
using the Fullerton Functional Fitness Test (Rikli & Jones, 1999a), subsequently
published as the Senior Fitness Test (SFT; Rikli & Jones, 2001). Results of this
study (shown in Figure 1) reveal remarkably consistent patterns of decline on all
test variables for both men and women—on chair stand and arm curl tasks, which
Figure 1 — Functional fitness performance across five-year age groups for 7,183 men
and women who were part of a nationwide study conducted to develop normative
performance scores for community-residing older adults, ages 60-94. Reprinted with
permission from Rikli & Jones (1999).
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reflect muscular strength and endurance; on 6-min walk and 2-min step tests, which
measure aerobic endurance; on sit-and-reach and back scratch flexibility tests;
and on an 8-foot timed up-and-go test, which involves speed, agility, and dynamic
balance. Interestingly, the percent of decline on these field-based functional ability
tasks were very similar to the declines found in laboratory-measured muscular
strength and aerobic endurance, with both indicating declines of approximately
10-15% per decade (Rikli & Jones, 1999b, 2001).
Of much greater interest, however, is the evidence suggesting that much (up
to 50% or more) of the physical and functional declines normally observed during
aging can be reduced through regular participation in physical activity, thus reducing
or preventing declines that can lead to physical frailty and disability in later years
(Hagberg, 1994; Jackson et al., 1995; Jackson et al., 1996; Rikli & Jones, 2001).
Although traditional disability models indicate that physical decline originates
from disease or pathology (Nagi, 1965, 1991), with disease leading to physical
impairment, impairment to functional limitation, and functional limitation to
disability, more recent evidence suggests that disuse or physical inactivity can be
equally as responsible for physical declines during aging (Chandler & Hadley, 1996;
DiPietro, 1996; Morey, Pieper, & Cornoni-Huntley, 1998; Rikli & Jones, 2001).
In fact, a number of large epidemiologic and other longitudinal studies clearly
suggest that physical inactivity, independent of chronic disease status, contributes to
physical declines during aging (Chandler & Hadley, 1996; Gill et al., 1996; Kaplan,
Strawbridge, Camacho, & Cohen, 1993; Lacroix, Guralnik, Berkman, Wallace, &
Satteerfield, 1993; Lawrence & Jette, 1996; Mor et al., 1989; Morey et al., 1998;
Rikli & Jones, 2001; Seeman et al., 1995; Stewart et al., 1994).
People with insufficient levels of physical activity, which is common among
most adults, can experience physical declines that eventually will lead to functional
limitations in tasks such as lifting, stooping, walking, or climbing stairs, all of
which are required for independent functioning. In fact, because of their sedentary
lifestyles, many older adults are functioning dangerously close to their maximum
physical capacity when performing normal everyday activities (e.g., getting out
of a chair, getting in and out of a bathtub, or climbing stairs; Chandler & Hadley,
1996; Evans, 1995; Shephard, 1997). Reducing the inactivity-induced physical
declines during aging is important to the quality of life for individuals, as it can
extend physical independence for as much as 10 to 20 years (Rikli & Jones, 2001;
Shephard 1997).
Figure 2 compares the performance of physically active older adults (those
who engage in 30 min or more of moderate-intensity physical activity at least three
days per week) with that of inactive older adults. These data, taken from the same
functional ability normative study referred to in Figure 1, suggest that for sedentary
individuals, approximately 50% of the decline in performance might have been
offset by being physically active (Jones & Rikli, 1999; Rikli & Jones, 2001). A 50%
reduction in age-related decline over a period of 30 years, for example, could be
interpreted as a 15-year “functional advantage” for active compared to inactive older
adults, meaning that active older people should be able to extend their period of
physical independence by approximately 15 years beyond what would be predicted
for their more sedentary peers (Rikli & Jones, 2001).
Maintaining health and functional ability in later years is also important
for economic reasons. Statistics show that it costs the United States $26 billion
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Figure 2 — Functional fitness performance across five-year age groups for active
and inactive participants in the same nationwide study referred to in Figure 1. Active
participants were those who engaged in 30 min of moderate intensity physical activity
at least three times a week; inactive participants were those who did not participate in
regular physical activity or who were active less than three times a week. Reprinted with
permission from Rikli & Jones (2001).
per year to care for people who have lost their independence, and these figures
are expected to increase drastically as the size of the older population continues
to grow (Alliance for Aging Research, 1999). Some are predicting that chronic
disease and disability in older Americans will overwhelm the nation’s health care
resources and will drive the cost of health care in this country for many years to
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come unless ways are found to reduce the prevalence of lifestyle-related health
and mobility problems in later years.
Role of Physical Activity and Exercise
in Reversing Age-Related Declines
In addition to reducing the amount of functional decline experienced during
aging, physical activity and exercise can also be effective in reversing declines
that already have occurred, even when the physical activity is begun late in life.
Research clearly shows that it is never too late to improve one’s physical fitness
and functional ability. Even people in their 90s have experienced dramatic benefits
from beginning an exercise program (Fiatarone et al., 1990). This is especially
good news when considering the potentially devastating effects of physiological
declines on the health and quality of life of older adults.
One common characteristic of the aging process (which appears to be
more a function of physical inactivity than of aging) is the loss of muscle mass.
Reduced muscle mass is often considered the “lead domino” in a whole chain
reaction of events that can have serious effects on people’s health and well-being
at any age, particularly during the later years. Age-related loss in muscle mass
(estimated to average 1% per year or as much as 10% per decade in low active
individuals) is associated with a decrease in basal metabolic rate (BMR), muscle
strength, and aerobic capacity (Evans, 1999). A decrease in muscle strength and
aerobic capacity, in turn, leads to further reductions in physical activity level and
in energy expenditure. These continued reductions in physical activity level and
energy expenditure lead to increased body fat and then to even further reductions
in muscle mass, metabolism rate, strength, and aerobic capacity, and the cycle
continues. To make matters even worse, most people do not adjust their caloric
intake to correspond to their reduced energy expenditure, which then contributes
to additional weight gain, obesity, increased incidence of Type II diabetes, and a
whole host of other health and mobility problems. Being overweight (overfat),
even in the absence of other diseases, is considered a major predictor of disability
in older adults (Evans, 2000).
Although it is generally recommended that exercise programs for older
adults include a variety of aerobic, strength, flexibility, and balance exercises,
research suggests that strength training (progressive resistance exercises) may be
the most important type of exercise for older people, since only strength training
can stop or reverse the damaging losses in muscle mass. Seguin and Nelson (2003),
in their recent review of the strength training literature, suggest that strength
training interventions, especially those utilizing progressive high resistance
training protocols, have been effective not only in increasing muscle mass, but
also bone mass, muscle strength, aerobic endurance, flexibility, dynamic balance,
self-confidence, and self-esteem. Further, most studies have found that the positive
effects of strength training, as well as other types of exercise, apply to the healthy
older adult population, as well as to those with various chronic conditions such
as arthritis, coronary artery disease, hypertension, and peripheral vascular
disease (Kaplan, Strawbridge, Camacho, & Cohen, 1993; Lacroix, Guralnik,
Berkman, Wallace, & Satterfield, 1993; McGuigan et al., 2001; Stewart et
al., 1994).
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Aerobic exercise training interventions also have produced positive results
in older adults, including improved oxidative capacity of muscles and improved
glucose tolerance, which is of importance in managing diabetes (Hughes et al.,
1993). Other studies have shown that exercise interventions not only result in
improved physical fitness (strength, endurance, etc.), but also in improved functional
ability (walking, stair climbing, etc.; Cress et al., 1991; Fiatarone et al., 1990,
1994; Nichols, Hitzelberger, Sherman, & Patterson, 1995; Pyka, Lindenberger,
Charette, & Marcus, 1994; Rikli & Edwards, 1991). In one particular two-year
intervention, continuous strength improvements during an exercise program were
accompanied by continued improvements in related functions such as walking,
stair climbing, and cycling throughout the entire two years (McCartney, Hicks,
Martin, & Webber, 1996).
Although there is strong evidence supporting the effectiveness of physical
activity/exercise as an intervention for reversing physiological declines in sedentary
people and for improving functional ability (rising from a chair, walking, stair
climbing, etc.), the evidence is less clear concerning the effectiveness of exercise
in treating people with already confirmed disability (i.e., those who have lost
the ability to perform common activities of daily living; Buchner, 2003; Keysor
& Jette, 2001). Keysor and Jette (2001), following a review of 31 intervention
studies between 1985 and 2000, concluded that late-life exercise has a positive
effect on reducing and even reversing impairments in strength, aerobic capacity,
flexibility, walking, and standing balance but that there was much less support
for exercise as a treatment of disability. However, it is possible that the lack of
observed exercise effects on disability in these studies could have been due to a
number of methodological limitations (inappropriate types of exercise interventions,
inadequate sample size, or difficulties in measuring disability, as examples) or
could be due to the complex nature of disability and the failure to consider other
relevant factors such as cognitive, social, and environmental issues. Other research
on treating physical disabilities, particularly those associated with balance problems
and reducing falls, has been much more promising. Although there is still much to
learn about the particular types of exercises that work best, it is recognized that an
individualized program that targets specific impairments and limitations will be
most effective (Campbell, Robertson, Gardner, Norton, & Buchner, 1999; Judge,
2003; Rose, 2003).
Regular physical activity also has been shown to have a positive impact on
a whole host of social and psychological factors including improved mood state,
reduced depression/anxiety, increased self-confidence, expanded social interactions,
and improved cognitive functioning, especially on increased cognitive processing
speed. Although a detailed discussion of these factors is beyond the scope of this
paper, the strength of the association between physical activity participation and
overall social/psychological well-being has been clearly communicated in a number
of summary reports (Chodzko-Zajko, 2000, 2005; Rowe & Kahn, 1998; World
Health Organization, 1997). Based on results from the MacArthur Successful Aging
Studies, for example, which considered the effects of numerous factors on overall
well-being, it was concluded that “physical activity is at the crux of successful
aging,” with successful aging defined in terms of social and psychological wellbeing as well as physical well-being (Rowe & Kahn, 1998, p. 98).
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What Matters Most:
Addressing the Physical Inactivity Epidemic
Despite a wealth of evidence (and strong public messages) documenting
the critical importance of regular physical activity in preventing chronic disease
and maintaining health and well-being, especially in later years, there has been
little success in motivating sedentary people to adopt physically active lifestyles.
Statistics continue to show that the majority of American adults (more than 2/3
of the population) do not engage regularly in moderate intensity physical activity,
with this statistic remaining largely unchanged over the past 15-20 years (Healthy
People, 2004).
Statistics of this type are extremely troublesome when considering the
potentially devastating effects of sedentary lifestyles that were mentioned earlier.
For many years, physical inactivity has been recognized as a serious “health risk”
that contributes to a number of chronic conditions including heart disease, diabetes,
obesity, hypertension, osteoporosis, and some types of cancer, yet this knowledge
does not appear to motivate changes in behavior.
Strategies to Increase Physical Activity Participation
For more than 20 years, researchers have been experimenting with
strategies to increase physical activity participation, focusing primarily on ways
of motivating individuals to begin and maintain an exercise program. Traditionally,
most intervention approaches have involved applying various cognitive and
behavioral change strategies (e.g., goal setting, peer modeling, self-talk, congnitive
restructuring, rewards and incentives, behavioral contracts, etc.) to increasing
exercise participation, with special attention given to improving self-efficacy and
readiness for change. Most of these behavioral change strategies and principles are
derived from psychological theories and models such as Social Cognitive Theory,
Health Belief Model, Transtheoretical Model, Theory of Planned Behavior, and
Relapse Prevention Model.
Unfortunately, past strategies to increase physical activity participation have
not yet led to a significant improvement in population-based participation rates or
to an increase in exercise adherence rates in most studies. The drop-out rate for
people who begin an exercise program continues to average about 50% within
6 months, although higher adherence rates have been reported in a few of wellcontrolled studies (Dishman, 2001; Dishman & Buckworth, 1997; Healthy People,
2004; Morgan, 2001; O’Neal & Blair, 2001). It has been suggested by some that
the principles from behavioral change theories, many of which were developed for
use in controlling undesirable behavior such as smoking, drugs, alcohol abuse, and
overeating, may not be as appropriate for use in promoting positive behaviors such
as physical activity (Dishman & Buckworth, 1997; Morgan, 2001).
More recently, the focus on increasing physical activity participation has
shifted from individual strategies to ecological or transdisciplinary approaches,
which are based on the principle that behavior is influenced by a wide range
of factors, including biological, psychological, social, cultural, policy, and
environmental (King, Stokols, Talen, Brasington, & Killingsworth, 2002; Sallis,
2003; Satariano & McAuley, 2003; Spence & Lee, 2003). Based on these principles,
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it is suggested that successful interventions would need to address all (or at least
many) of these factors. Such an approach would require combining concepts and
expertise from multiple fields such as exercise science, behavioral science, urban
planning, transportation, and parks and recreation, among others.
Although in reality it would be almost impossible to address all components
of ecological/transdisciplinary theory within one intervention, there definitely is a
clear trend in research design and in federal funding initiatives toward multifactorial
approaches to improving physical activity participation. The National Blueprint,
based on input from 46 organizations with expertise in health, medicine, social
and behavioral sciences, public policy, and environmental issues, is an example
of such an effort (Shephard et al., 2003). The major goal of the Blueprint is to
bring organizations together to develop initiatives that will result in multilevel and
cross-cutting strategies for increasing physical activity participation in middle-age
and older adults.
Are There Other Issues That Should Be Considered?
On a personal note, I am encouraged by the new, more broadly-based theories
and models for increasing physical activity participation rates (ecological theory,
transdisciplinary models, etc.). I am optimistic that this approach will finally lead
to an increase in the number of people who participate in regular physical activity.
However, based on my own experiences over the years in studying and promoting
adult physical activity, I would suggest that there may be at least two other important
issues that warrant attention—(a) the lack of research on successful exercisers,
especially relative to understanding the specific phenomena (motivating factors) that
have led previously sedentary people to become committed exercisers—”exercise
converts,” as they are sometimes called and (b) the limited attention directed to the
most frequently-cited barrier to exercise—lack of time.
Lack of Research on Successful Exercise Converts. A review of the literature
on exercise motivation suggests that we have very little research, and therefore only
a very limited understanding, of what it is that has motivated previously sedentary
people in the past to become active and stay active. Even though past research has
resulted in little change in the overall physical activity participation statistics for
the nation, there certainly have been numerous examples of previously sedentary
adults who have, for one reason or another, made a decision to begin an exercise
program and to remain physically active. Unfortunately, there has been little, if
any, systematic effort to study and learn more about these individuals who already
have successfully accomplished exactly what we are trying to get the rest of the
sedentary population to do—to become physically active. Of special importance,
it would seem, would be information about the specific factors or motivators that
lead sedentary people to become active—to become an exercise convert. Most of
us probably know a number of people who fit this category—people who were
sedentary at one time, but who, usually because of some identifiable event or
condition, have become a regular, committed exerciser. Again, this would appear
to be exactly the category of people that we should spend time studying in some
detail, so that we can learn much more about factors that are most important in the
decision to convert from being sedentary to being physically active.
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Past studies have made us aware of the many reasons (barriers) that people
give for not exercising (lack of time, lack of motivation, lack of opportunity, etc.),
but we do not have enough information about the specific events or conditions that
have led people to make positive changes in their behavior, especially changes
which have lasted over time. As we look at other areas of human development (e.g.,
promotion of successful management/leadership behaviors, coaching techniques,
or effective sales tactics), we find that most theories, principles, and strategies
are based on knowledge gained from studying those who have been especially
successful in the past, not those who have been unsuccessful. Effective, wellregarded leadership theories, for example, have been developed based on studying
the habits of “outstanding performers” and “star leaders” in various companies
and organizations (Goleman, Boyatzis, & McKee, 2002). We have not adequately
utilized this strategy, however, to learn more about how to promote positive exercise
and health behaviors.
A comprehensive understanding of the phenomenon surrounding positive,
committed exercise habits would probably best be acquired through qualitative
research techniques, with the “grounded theory” approach appearing to be
especially well-suited to studying the factors and conditions that have been
successful in helping sedentary people become active. The intent of grounded
theory research, according to qualitative research specialists, is the development
or generation of a theory that is closely related to the context of the phenomenon
being studied (Creswell, 1998; Glaser & Strauss, 1967; Strauss & Corbin, 1990).
Per Thomas and Nelson (2001), “a theory based on and evolving from data is called
a grounded theory. . . . In applied research, grounded theories are considered the
best at explaining observed phenomena, understanding relationships, and drawing
inferences about future activities” (p. 346).
Limited Attention to the Most Frequently-Cited Barrier to Physical Activity.
A second observation about past attempts to increase physical activity participation
is that little research appears to have been directed toward the main reason that
most people give for not being physically active—i.e., a lack of time. Over and
over, lack of time is mentioned as the number one reason most adults give for not
participating in regular physical activity (Collins, 2004; Dishman, 2001; Morgan,
2001; Sallis & Owen, 1999; Wilcox & King, 2005), yet few interventions seem
to directly address this issue. For the most part, of course, not enough time can be
translated to mean that an activity is not a priority or at least not a high enough
priority. Certainly, this is a very real issue for many people who are experiencing
increasing demands and pressures on their time as they try to balance career, home,
family, friends, and other social and civic responsibilities. Who doesn’t agree that
the pace of life for most people in our high tech world, where e-mail and the
internet now occupy so much of our time, hasn’t become busier than ever before
and often more stressful?
With counselors and psychologists reporting that the most common source
of stress for most people is difficulty managing all the competing demands on their
time, it is no wonder that lack of time is a common (and probably real) reason why
so many people find it difficult to maintain a program of regular physical activity.
In fact, lack of time (or a perceived lack of time) for many is almost certainly a
greater barrier than are other factors that traditionally have been assumed to be
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important, such as lack of self-efficacy, lack of social support, or lack of
opportunity. So, recognizing the critical value of physical activity, how can
we, as concerned health professionals, help people see the importance of
fitting just one more thing into their life along with all of the other important
demands on their time?
A well-recognized first step in any effort to change behavior (such as
beginning an exercise program, losing weight, or better managing one’s stress)
involves values clarification (Blonna, 2000; Seligman, 2002). However, just telling
people about the benefits of physical exercise and encouraging them to set exercise
goals does not necessarily help them to immediately value exercise or make it a
top priority for them, even though they know that it is important. Goal setting or
priority-setting that focuses only on one behavior (such as physical activity), apart
from other values and goals, does not help people put that activity into hierarchical
perspective with all other demands on their time.
Successful time management (the same as successful life management)
requires having a clear picture of higher order values and goals, as well as an
effective system for planning and prioritizing activities related to these goals
(Aspinwall & Staudinger, 2003; Seligman, 2002). Part of the issue for many nonexercisers is that they probably are not even thinking about their health and own
personal wellness as being a higher order priority that ought to be considered
in their daily/weekly planning. It is presumed that many people do not actually
spend much time thinking about their higher order values and priorities at all, and
as a result, do not schedule their time and manage their lives according to clearly
established values and priorities.
For those people who do not regularly think about their personal goals and
values, a successful approach in helping them assume more responsibility for their
own health and lifelong well-being may require special attention to higher order
values clarification. If people are not thinking about what really matters most to
them (i.e., do not have a clear picture of their values) and are not planning their
days and managing their time according to their established values, then it is very
unlikely that they will see the importance of fitting daily exercise into their already
busy lifestyles.
Although a detailed discussion of values clarification and time management
is well beyond the scope of this paper, I will briefly summarize what the gist of
such a process might entail. The sample procedures described below are based on
course units and workshops that are offered on my own campus as part of our highly
popular Personal Health and Stress Management courses in the General Education
program and as part of the Employee Training and Development program for faculty
and staff. Interestingly, there are numerous examples of faculty, staff, and students
who have made significant and long-lasting changes in their health and physical
activity habits as a result of these workshops/courses, even though increasing
physical activity was not at all the purpose of the sessions. The purpose of these
workshops/course units is to help people clarify their own personal values and goals
(what’s most important to them) and then develop strategies to better manage their
time and their lives according to these goals. If good health and fitness (including
weight management) surfaces as a top value and priority for people, which more
often than not it does, then people begin to perceive that physical activity and
exercise deserve a higher place of importance in their daily/weekly planning.
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The following is a brief outline of the steps commonly followed in time
management and values clarification workshops and course units:
1. The course leader engages participants in a discussion of the importance of
planning one’s time effectively. Effective planning is necessary for managing
stress and for reaching optimal personal and professional productivity,
inner peace, balance, happiness, and overall satisfaction with one’s life
(Aspinwall & Staudinger, 2003; Covey, 1990; Covey, Merrill, & Merrill,
1996; Griessman, 1994; Seligman; 2002).
2. Next, participants are reminded that meaningful and effective time
management requires a clear picture of their personal values and goals
(of what will matter most to them over the years ahead). As an exercise in
helping with their values clarification, participants are asked to list the 4 to
6 things that they believe will matter most to them at some future point in
time. Middle-aged and older adults often choose a time close to or after their
retirement. Younger people might select a time when they hope to be at the
height of their career. It is important to keep the list of values/goals short,
to help people think through what is most important to them—what their
highest values are.
3. Participants are then asked to think about what they need to be doing now
in order to reach these goals and, in fact, to think about the degree to which
their current lifestyles and daily activities are consistent with these goals and
values. For each goal, such as in the examples listed below (which happen
to be similar to my own retirement-age goals), participants should carefully
think about what it will take to be successful in reaching that goal and whether
or not they are planning their time and managing their lives with their own
“higher order” goals in mind.
•
•
•
•
•
•
Good health/fitness
Close family and friends
Satisfaction with career/record of service
Financial comfort
Exciting hobbies/interests
Spiritual peace
4. To further strengthen participants’ depth of commitment to their goals, there
are numerous additional exercises that can be helpful: Session leaders might
tell the participants that they must eliminate one of their goals/values and ask
them to choose which one it will be. This typically has a powerful effect on
helping people realize how really important their goals are—and, in fact, most
will be unable to do this, saying that all are essential. Another enlightening
exercise especially effective as a small group discussion, is to ask participants
to predict which goal they will be least successful in reaching and to identify
the reasons why they might not reach this goal.
Interestingly, relative to point #4 above, a goal that most people consider as
one of their most important (least willing to give up) is good health and fitness. Yet,
ironically, this also turns out to be the same goal that most people predict they will
be least effective in reaching, often for reasons that they acknowledge are within
their control—poor diet, being overweight, not enough exercise, and substance
60
SUCCESSFUL AGING
abuse, in some cases. As a result, almost all who participate in workshops/class
sessions such as these end up with a significantly stronger view of the importance
of their health and fitness and the importance of paying attention to it now, since
they realize that they may not be on track to reach one of their most important future
goals. When people realize that their health, which they previously may not have
thought much about on a day-to-day basis, clearly shows up as being close to the
top, if not at the top, of their very select group of values and goals, this tends to
get their attention and in some cases causes what many have referred to as a “life
changing experience” relative to what they consider as priorities in their lives. It
is also interesting to note that for many, physical activity and recreational pursuits
take on added importance in their lives not only because of health benefits, but
also because of their potential relevance to other goals—such as providing a way
of spending more time with family and friends and of contributing to one’s own
excitement, enthusiasm, and joy for life, all of which are worthy and important
goals for a successful life.
Summary
Due to demographic shifts and increasing life expectancy, it is predicted that
the population of adults over the age of 65 will double by the year 2030, increasing
from 35 million to 70 million. However, data also indicate that increased length
of life is not associated with improved health. In fact, statistics show that there
is a trend toward increased prevalence of lifestyle-related chronic disease in the
over 70 population and an accompanying decline in self-rated health in the fastgrowing 85+ population. Unless ways are found to reverse these trends, there could
be devastating consequences relative to increased health care costs and quality of
life in later years.
With successful aging defined as having low probability of disease/disability,
high cognitive and physical capacity, and active engagement in life (Rowe & Kahn,
1998), it is important to give special consideration to factors that support these
conditions. It is well-documented that regular participation in moderate-intensity
physical activity can play a significant role in controlling many chronic diseases,
in reducing declines in functional ability, and can be effective in reversing many
declines which already have occurred. Participation in physical activity is also an
excellent mechanism for increasing social opportunities and remaining actively
engaged in life.
Unfortunately, despite many years of research on interventions to increase
regular physical activity participation, statistics continue to show that the majority
of Americans live mostly sedentary lifestyles, with less than one-third engaging
in the recommended 30 min of moderate intensity physical activity on most days
of the week. Recent trends toward a more broad-based, multifactorial approach to
improving physical activity participation rates are encouraging, especially strategies
based on ecological and transdisciplinary theories and models, which include
consideration of psychological, social, biological, cultural, policy and environmental
factors. Future planning based on principles from these theories/models would
involve input from specialists in many fields such as exercise science, behavioral
science, city planning, and parks and recreation as strategies (programs, facilities,
space, etc.) are developed to increase participation in physical activity.
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61
Finally two additional observations were made that may be worthy of
attention. It was suggested that important new information might be learned
by researching and learning more about successful exercises, particularly those
people who once were sedentary, but have become committed exercise converts.
In particular, it was suggested that grounded theory qualitative methodology might
be an especially effective method of studying the various factors and conditions
that have led formerly sedentary people to become exercisers, with the end result
perhaps being the evolution of a new theory specifically addressing factors related
to long-term physical activity participation.
A second observation was that we appear to have given insufficient attention
to the most frequently-cited barrier to regular participation in physical activity—that
of lack of time. Because lack of time can usually be translated to mean lack of
priority, it was further suggested that perhaps exercises in values clarification ought
to be part of interventions or programs designed to improve physical activity level.
It was pointed out that a first step in helping people rethink their priorities and make
changes in their behavior requires them having a clear picture of their higher order
values and goals. Focusing only on the importance of exercise goals, apart from
all other demands on time, may not provide people with the perspective needed
to appropriately prioritize their activities. Experience suggests that exercises in
values clarification almost always results in a stronger realization of the importance
of one’s health relative to other values in life and the corresponding importance
of placing a higher priority on healthy behaviors, including a new or renewed
commitment to exercise.
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Author Note
1
As a side comment, it would appear that many of the principles and messages from the
“positive psychology” approach to life management could be helpful to the field of exercise
science as we grapple with finding better ways to motivate people to adopt healthier behaviors,
such as regular physical exercise, and to take more responsibility for their own long-term health
and well-being. Arguing that scientific psychology has focused disproportionately on pathology
and individual limitations and weaknesses, Seligman, Czikszentmihalyi, and others have proposed
a shift in focus to that of studying people’s strengths and positive behaviors, particularly relative
to investigating the positive aspects of well-being and health (Aspinwall & Staudinger, 2003;
Seligman, 2002; Seligman & Czikszentmihalyi, 2000).