University of Groningen
Ageing with joy
Chang, Chang Ming Sing
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Chang, C. M. S. (2009). Ageing with joy: the effect of a physical activity programme on the well-being of
older people Groningen: s.n.
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Chapter 1
General Introduction and Aims
of this Thesis
Introduction
The world’s population has been growing rapidly during the last decennia and will
even more increase in the next two decades. The situation in Suriname is similar
to this global trend. Within this increasing number the group of elderly people (as
generally used by the UN being over 60 years of age)1 deserve to be mentioned
separately as this group through a variety of reasons grows faster than the other age
groups.
Ageing in Suriname, and in general also in the world, is considered as a stage in
life for slowing down, to retire, to rest and to be less active. On the other hand ageing
is also associated with illness, less physical fitness, and greater dependency. However,
over the past years research has shown the positive impact of physical activity on
health and physical fitness, eventually leading to maintain or even increase the
quality of life.
This chapter is divided into two parts: Part 1 and Part 2. In the first part a general
overview of the demographics of older population of the world, and the trends
contributing to the increase in the number of the elderly group is presented together
with the changes in disease which lead to this increase. Also a description will be
given of Suriname, the population and the general health status. The situation of
the elderly in Suriname as well as of the facilities for the elderly in Paramaribo, the
capital of Suriname, is described.
In Part 2 the theoretical background of health, physical fitness, physical activity
and the relation between each of them, and the impact of physical activity on health
of individuals is discussed. To understand the role of each of the different items
involved in these processes it is important to clearly define each one of them. In the
first paragraph of this part the different definitions are mentioned and extensively
discussed, while the second paragraph tries to explain the relationships as formulated
in the Toronto model (Bouchard et al., 1990)2 between physical activity, healthrelated fitness and health. In the last paragraph of this chapter the relation between
ageing and physical fitness as mentioned in the literature is briefly indicated. It will
be discussed in great length in the next chapter together with the influence physical
activity programmes can have on the health and physical fitness of elderly people.
This chapter ends with formulating the aims of this study.
Chapter 1 | General Introduction and Aims of this Thesis
11
Part 1 General Overview Older Population in the World
and in Suriname
1.1 World demographics
1.1.1 The increasing population
According to the United Nations report ‘World Population Prospects: The 2004
Revision’ (2005)3 the world population has reached 6.5 billion by end of 2005.
Approximately 5.3 billion (or 81%) is said to be living in the less developed regions.
It is anticipated that the world population will continue to increase dramatically in
the next few decades (see Table 1.1).
Table 1.1 Population of the world, major developments groups and major areas.
1950, 1975, 2005 and 2050, by projections variants
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2005).
World Population Prospects: The 2004 Revision Highlights. New York: United Nations.
Population (millions)Populations in 2050 (millions)
Major area
1950
1975
2005
Low
Medium
High
Constant
World
2,519
4,074
6,465
7,680
9,076
10,646
11,658
More developed regions
Less developed regions
Least developed countries
Other less developed countries
813
1,707
201
1,506
1,047
3,027
356
2,671
1,211
5,253
759
4,494
1,057
6,622
1,497
5,126
1,236
7,840
1,735
6,104
1,440
9,206
1,994
7,213
1,195
10,463
2,744
7,719
Africa
Asia
Europe
Latin America and the Caribbean
Northern America
Oceania
224
1,396
547
167
172
13
416
2,395
676
322
243
21
906
3,905
728
561
331
33
1,666
4,388
557
653
375
41
1,937
5,217
653
783
438
48
2,228
6,161
764
930
509
55
3,100
6,487
606
957
454
55
Distinct trends in fertility and mortality are underlying this pattern of growth.
There has been a decline in the proportion of children and young people and an
increase in the proportion of people age 60 and over, which resulted in a transition
of the age distribution figure. The demographic consequence of the decline of both
fertility and mortality is that the composition of age groups has changed dramatically
in the past decades. The triangular population pyramid of 2002 will be changed into a
more urn-like diagram in 2025 (see Figure 1.1). One can expect this to be a temporary
phenomenon since in the future this will be leveled out again, especially in developing
countries with a high life expectancy at birth (LEB).
The situation, seen from a gender perspective in general, shows women
throughout the world in general have a higher life expectancy than men (United
Nations, 2001)4.
12
Ageing with joy
Figure 1.1 Global population pyramid in 2002 and 2025
As has been already explained before, the ageing of a population is the result of
2 major factors i.e. decreasing mortality, which automatically translates into an
increased LEB and a decreased total fertility rate (TFR), which leads to a diminished
or possibly even negative accrual of the younger age groups that are in time
necessary to replace the older ones. The net result of these two processes will be the
steady increase of the number of older people in the different age groups within the
population. In this instance it leads to a deformation of the population pyramid but
it can be only temporarily.
Figure 1.2 shows the increasing of life expectancies at birth in different regions of
the world over the past decades.5 In this diagram the line of Latin America and the
Caribbean shows a steep increase of the LEB.
Figure 1.2 Life expectancy at birth in the world’s regions from 1950 to 2035
Source: United Nations, 1999.
Chapter 1 | General Introduction and Aims of this Thesis
13
The world is currently at the threshold of rapid global ageing. Within the next
decades there will be an increase of the absolute as well the relative numbers of
older people. This rapid growth will be observed in both developed and developing
countries.
The percentage of older people in the different parts of the world may differ to
a great extent. The UN considers anyone above the age of 60 to be old, whereas in
The Netherlands and the European Union 65 marks the age at which people are
generally being retired, while in some instances even people 55 of age are called old.
This discrepancy in the different definitions of the term ‘old’ may make generalized
data difficult to interpret.
Figure 1.3 shows that the largest percentage of elderly of the total population in the
next few decades will be in the less developed world. With regard to Latin America
and the Caribbean, including Suriname, within 50 years this percentage will be
doubled, thus contributing to the total world population to a considerable extent
from 7 percent in 1975 to 14 percent in 2025.
Figure 1.3 Percentage of older persons (60 years and older) of the total population in 1975,
2000, and 2025
LAmC = Latin America and the Caribbean; NAm = North America. Source: United Nations, 1999.
Between 1990 and 2025 more developed countries (such as most of the European
countries, the USA and Japan) will experience a significant increase from 30% to
130% in their older population, whereas less developed countries (such as the
African, some Asian and Latin American countries) will show an increase which will
be even more dramatic (up to 400%) over the same period (see Figure 1.4)6.
14
Ageing with joy
Figure 1.4 Increase in the older population (60 years and older) from 1990 to 2025 in
selected countries
Source: Kinsella & Taeuber, 1992.
1.1.2 Influence of diseases
Another trend which can be observed in all developed countries and is also seen in
most of the developing world during the last decades is the shift in the pattern of
diseases. The reason for this shifting is the industrialization which leads to changes
in patterns of living and working. These changes affect developing countries most
since they experience the rapid increase of non communicable diseases (NCDs)
while infectious diseases, malnutrition and childbirth problems are still manifest.
This transition of pattern of diseases results in changing of causes of death and
morbidity. Many diseases become chronic instead of leading to death in an early
stage. Chronic illnesses such as heart diseases, cerebral vascular diseases, cancer,
high blood pressure and depression are becoming more and more the leading causes
of morbidity and mortality.
Figure 1.5 shows the transition of the epidemiology in 1990 to 2020 in developing
countries and in newly-industrialized nations7. In 1990, 49% of the disease burden
in these countries was attributable to communicable diseases and 51% to NCDs,
mental health disorders and injuries. By 2020, NCDs alone are expected to be
responsible for 43% of the deaths and will become the leading disease burden in
these countries in the next decade. Together with mental health disorders and
injuries the total disease burden will be 78%, while infectious diseases such as
diarrhoeal diseases or tuberculosis are expected to become increasingly less
common.
Since diseases have not been described as separate entities but more as a part of
the concept ‘illness’ it does not seem appropriate to describe every single disease
in terms of ‘incidence’ or ‘prevalence’ etc. Each of the chronic diseases results in a
diminished urge to move and decreased mobility especially in elderly people and
‘illness’ and not ‘one of the diseases’ leads for that reason to an exacerbation in itself
and an increase of the impairment.
Chapter 1 | General Introduction and Aims of this Thesis
15
Figure 1.5 Global burden of disease in 1990 and 2020 in developing and newlyindustrialized countries, contribution by disease group
Source: Murray & Lopez, 1996.
All the chronic diseases mentioned before are significant causes of disability,
which can make it difficult to carry out the activities of daily living and will result in
dependency of the person especially in the aged. This leads to an increasing burden
for the individual patient and also for the society as a whole.
Other data available, however, suggest that old age should not per se be seen
as equal to frailty, sickness and dependency. Disabilities associated with ageing
and the onset of chronic disease can in many instances be prevented or delayed.
Research in the USA (Manton and Gu, 2001)8 (see Figure 1.6) showed that in spite of
the substantial increase in the numbers of older people population the actual number
of disabled older persons (aged 65 years and over) has remained unchanged since
1982. These results are said to be related to increased education levels, improved
standards of living and better health, changed lifestyle behaviours (i.e. increases of
physical activity, decline in smoking behaviour), and an increase in the use of aids
(i.e. walking aids, telephones).
Figure 1.6 Number of older persons in the US.
Total older population versus activities of daily living-disabled population
Source: Manton & Gu, 2001
16
Ageing with joy
1.1.3 Promotion of an active lifestyle
Generally spoken ageing and a decline of fitness go hand in hand. This decline partly
is natural: the primary ageing process. On the other hand the decline for example
of physical fitness is also based on the lifestyle which is characterized by a less versatile
and less intensive physical activity, and on the deterioration of health: the secondary
ageing process. Less versatile and less intensive physical activity partly comes into
being by a natural decrease and partly because of the less demands of daily life.
Deterioration of health develops by a progression of increase of chances of
degenerative diseases with ageing: the so-called old-people’s diseases.
As people age, their quality of life is largely determined by their ability to maintain
autonomy and independence. To attain this goal the developed countries have
introduced physical activity programmes especially designed for the older adults
and the elderly. The effects of these programmes are of such a magnitude that they
will be indispensable to cope with the problems that arise from the growing of the
large cohort of elderly people. In the next part of this chapter and in Chapter 3 we
will elaborate on this extensively.
1.2 Suriname
1.2.1 Geography, history and demographics
Suriname, forming part of the three Guianas, is located on the north-east coast
of South America, between 2° and 6° N and between 52° and 56° W. The Peoples
Republic of Guyana (former British Guiana) is the neighboring country in the west,
French Guiana in the east and Brazil in the south. Being situated close to the equator
Suriname is known for its tropical climate.
Suriname became independent on 25 November 1975 and has at present the
status of a constitutional democratic republic. Before this period Suriname was a
Dutch colony and afterwards an autonomic part of the Kingdom of the Netherlands.
Other former rulers in the past were the Spanish, the Portuguese, the British and the
French. English and French names of places are still witnesses of these periods. Also
the left hand traffic in Suriname is a relic of the British period. The official language
of the country is Dutch.
Suriname is known as a multi-ethnical and multicultural society with the Amerindians as its indigenous population and descendants of immigrants who came from
three continents of the world: Europe, Africa and Asia. The former rulers and settlers
came from various parts of Europe: Spain, the United Kingdom, France, Portugal,
Germany, and The Netherlands. They brought slaves from various areas of Western
Africa. Descendants of the slaves, who stayed at the plantations and in the coastal
area until their freedom, are now called the Creoles. And descendants of the ones,
who ran away into the jungle and formed their own society in the interior, are called
the Marroons. After the abolition of the slavery in 1863 there was a shortage of
workers and to compensate this deficit laborers from various parts of Asia were
brought to Suriname during the period 1853-1930. The first immigrants were the
Chapter 1 | General Introduction and Aims of this Thesis
17
Chinese who came in 1853. In 1873, the first East Indians (from former British East
India, presently known as India) were brought in Suriname as contract laborers.
Descendants of these immigrants are currently known as Hindustanis. In 1890,
the first Javanese (from Java) from the former Dutch East Indies (another former
colony of Holland, presently known as Indonesia) were also brought to Suriname
as contract laborers. All those immigrants brought their cultures from abroad
with them and have to a certain extent kept their traditions throughout the years.
In the period directly prior to the Independence in 1975 many Surinamese were
uncertain about the future of the country; at that time more than 150.000 persons
migrated to The Netherlands. Following the political instability during this period, a
coup d’etat took place in 1980 and a military regime replaced the civilian government.
A decline in the political and the economical situation resulted in another mass
immigration during the nineties. In 1991 a democratic elected government was
established and stability in the political situation gradually restored.
1.2.2 Language
Suriname as a Dutch speaking country is surrounded by countries with three other
different languages: English, French and Portuguese. Because of the composition
of its population Suriname is also a multi-lingual country. Everybody can speak
at least three different languages: Dutch, Surinamese and a mother tongue. Even
though Dutch is the official language, used in the administration and schools, all
languages from the former immigrants (the mother tongue) are still spoken. Sranan
Tongo, the native Surinamese tongue (a lingua franca), which once was used as a
communication tool between the different linguistic groups, is presently spoken by
everybody. This native tongue is a mix of all languages that once were spoken in the
Surinamese history. Sranan Tongo has developed since slavery and comprises also
elements of English, Dutch, Spanish, Portuguese and French. Other languages still
frequently used in Suriname are Chinese, Sarnami Hindi, Javanese, and the various
Marroon and Indigenous languages. English is compulsory in the educational
system while Spanish is also taught at the secondary schools. With the increase of
tourists from neighboring French Guiana and immigrants from Brazil, especially
the younger population in Suriname has added French and Portuguese to their
language skills.
1.2.3 Religion
With the many ethnic groups present, Suriname has also a multi-religious society.
The Indigenous people and the Marroons who live in the interior still maintain their
traditional religion. The Europeans brought Christianity in the past and according
to the last census report in 2004 about 40% of the total population of Suriname is
Christian9. The majority of Christians can be found in the black society living in the
city (Creoles), and in small groups of Javanese, Chinese, Hindustani and Caucasians.
About 15% of the total population of Suriname is Muslim (Javanese and Hindustani)
and 20% is Hindu.
18
Ageing with joy
1.2.4 The population of Suriname
At the last census, held in August 2004, the total population of Suriname was 493.000.
According to the statistics of the General Bureau of Statistics - Suriname (Algemeen
Bureau voor de Statistiek / Censuskantoor)9 248.000 were men and 245.000 women.
(Table 1.2).
Table 1.2 Total population of Suriname, divided in age and gender groups
Source: General Bureau of Statistics - Suriname, August 2005
Age group
0 - 14 years
15 - 59 years
60 +
Not reported
Total
Total
146.327
299.410
42.175
4.917
492.829
Males
Females
Number
Percentage
Number
Percentage
74.308
151.032
19.712
2.794
247.846
15.1 %
30.6 %
4.0 %
0.6 %
50.3 %
72.019
148.378
22.463
1.758
244.618
14.6 %
30.1 %
4.6 %
0.4 %
49.7 %
Sex not
reported
365
365
The population pyramid of Suriname Census 2004 (See Figure 1.7) shows
an equal distribution between men and women in the age group 0 to 19 years,
a higher number of men than women in the age group 20 to 49 years, while
from 50 years on the numbers of women are higher than the numbers of men.
Figure 1.7 Age distribution of the Surinamese population in men and women, Census 2004
Source: General Bureau of Statistics - Suriname, August 2005
Chapter 1 | General Introduction and Aims of this Thesis
19
The largest ethnic groups are the group of the black people, which can be divided
in the group of the Marroons (14.7%) and the group of the Creoles (17.7%), the Hindustani group (27.4%), the Javanese group (14.6%), and the so called Mix group (12.4%).
The distribution in ethnicity of the total Surinamese population is shown in Table 1.3.
Table 1.3 Number and percentage of the different ethnic groups in Suriname at
2 August 2004, divided in groups of men and women
Source: General Bureau of Statistics - Suriname, August 2005
Ethnic group
Total
Population
Percentage
of the total
population
Men
Women
Sex not
reported
Indigenous
Marroon
Creole
Hindustani
Javanese
Chinese
Caucasian
Other
Mixed
Not reported
Total
18.037
72.553
87.202
135.117
71.879
8.775
2.899
2.264
61.524
32.579
492.829
3.7 %
14.7 %
17.7 %
27.4 %
14.6 %
1.8 %
0.6 %
0.5 %
12.4 %
6.6 %
100%
9.039
33.873
43.958
68.948
36.808
4.721
1.660
1.232
31.411
16.196
247.846
8.988
38.680
43.210
66.084
35.048
4.054
1.239
1.032
30.085
16.198
244.618
10
34
85
23
28
185
365
Table 1.4 shows the distribution in age ranges of the group of the population in
Suriname 60 year and older, while Table 1.5 reflects the distribution in ethnicity of
this population.
Table 1.4 Population in Suriname 60 years and older at 2 August 2004,
divided in groups of men en women
Source: General Bureau of Statistics - Suriname, August 2005
Age group
60 – 64 years
65 – 69 years
70 – 74 years
75 – 79 years
80 – 84 years
85 – 89 years
90 – 94 years
95 - 98 + yrs
Total
Total
Men
Women
Sex not reported
13.259
10.602
8.659
5.152
2.853
1.075
460
129
42.189
6.200
5.148
4.101
2.418
1.235
392
184
34
19.712
7.059
5.452
4.554
2.732
1.618
677
276
95
22.463
2
4
2
6
14
The largest percentage people of 60 years and older is found in the group of
the Caucasians (17.6%), followed by the Creoles (12.2%), and the Javanese group
(11.5%) (See Table 1.5). In general there are more women than men. Only in the small
ethnic groups (Chinese, Caucasian and Other) the number of men is higher than
the number of women, while the ratio men : women in the group of the Javanese is
almost equal (49.8% : 50.2%).
20
Ageing with joy
Table 1.5 Number and percentage ethnic groups 60 years and older in Suriname at
2 August 2004, divided in men and women
Source: General Bureau of Statistics - Suriname, August 2005
Ethnic group
Indigenous
Marroon
Creole
Hindustani
Javanese
Chinese
Caucasian
Other
Mixed
Not reported
Total
Total
Population
18.037
72.553
87.202
135.117
71.879
8.775
2.899
2.264
61.524
32.579
492.829
Total
> 60
Population
1.596
4.486
10.605
10.171
8.258
737
510
234
3.943
1.649
42.189
Percentage
> 60
of the total
population
8.8 %
6.2 %
12.2 %
7.5 %
11.5 %
8.4 %
17.6 %
10.3 %
6.4 %
Men
> 60
776
1.918
4.736
4.762
4.113
420
307
153
1.718
809
19.712
Percent.
men > 60
of total
> 60
48.6 %
42.8 %
44.7 %
46.8 %
49.8 %
57.0 %
60.2 %
65.4 %
43.6 %
Women
> 60
820
2.568
5.863
5.408
4.143
317
203
81
2.225
835
22.463
Percent.
Women
> 60 of
total > 60
51.4 %
57.2 %
55.3 %
53.2 %
50.2 %
43.0 %
39.8 %
34.6 %
56.4 %
In Suriname like in South America the situation with regard to the changes in
the age distribution does not differ very much from the rest of the world. There is a
definite increase of the number of older people also in Suriname, which has a history
of its own that gives rise to an even greater number of elderly relatively speaking
than the countries that surround it. In 1990 the mean life expectancy for the total
population of Suriname was 68.7 years. The average life expectancy for men was
66.2 years, while for women 71.2 years. In 2000 the mean life expectancy for the total
population has been increased to 70.7 years, while the average life expectancy for
men was 68.1 years, and for women 73.3 years (Alleyne, 2002)10.
1.2.5 Mortality in Suriname
Suriname experiences the same difficulties and the same transition in epidemiology
as other countries in South America. Definite data however on the incidence and
prevalence of the non-communicable diseases are still lacking.
Data of the Bureau Openbare Gezondheidszorg (Bureau of Public Health, 2004)11
have shown a dramatic increase of the mortality rate of non communicable diseases
in the past decade, which may be a reflection of the incidence and prevalence.
Heart and vascular diseases are leading causes of death in Suriname (see Figure
1.8). Cerebro-vascular accidents are included in this number. Together with diabetes
mellitus this disease accounts for 1000 deaths (33.3%) of all causes of deaths in
Suriname. Cancer takes the second place in this ranking with 341 deaths (11.3%).
Chapter 1 | General Introduction and Aims of this Thesis
21
Figure 1.8 The 10 most important causes of deaths in Suriname, 2002
Source: Bureau Openbare Gezondheidszorg, 2002
Heart
CancerPeriExternal
Diabetes
and
natal
causes
Mellitus Vascular
periods
(injuries,
Diseases
assault & suicide)
AIDS
GastroTractus
Acute
intestinal urogenitalis pulmonary
diseases
diseases
diseases
Chronical
liver
diseases
Other
diseases
Figure 1.9 shows the distribution of causes of death in all ages per ethnical group
with the highest scores. The Hindustani population has the highest rate, 38.4%
(N=321) for heart diseases, followed by the Creole people with 27.3% (N=228). Death
caused by diabetes mellitus shows the same pattern: Hindustani population as the
highest, 43.3 % (N=71) and second, Creole with 22.0% (N=37). The frequency of
deaths caused by cancer is different; the Creole population has a higher percentage,
44 % (N=144), followed by the Javanese with 20.4% (N=66).
Figure 1.9 Number of deaths by different causes in all ages
per different ethnical group in 2002
Source: Buro Openbare Gezondheidszorg, 2002
22
Ageing with joy
Given the ratio between men and women 60 years and older, who died in 2002,
heart/vascular diseases (331:282) and cancer (126:107) appear to be higher among
men, while the main cause for deaths among women (40:54) appears to be diabetes
mellitus (Fig. 1.10).
Figure 1.10 Number of deaths by different causes men and women
60 years and older in 2002
Source: Bureau Openbare Gezondheidszorg, 2002
1.3
The status of elderly care in Suriname
1.3.1 Bureaucratic institutions
Like many other traditions and customs also the political and bureaucratic system
of Holland was copied in Suriname. This also holds true for the healthcare system
of Suriname which is also in principle the same as in Holland. The Minister of
Health, who is politically responsible for the healthcare system has at his disposal a
department, which is in charge of the primary health care in Suriname and which is
called BOG (Bureau Openbare Gezondheidszorg i.e. Bureau of Public Health).
The governmental policy regarding healthcare, especially at older age, was more
focused on curative care than on prevention. There is still no national plan for senior
citizens available. Also at the level of health sector reform planning there is still no
clear policy defined as yet by the government for the elderly. This is also reflected
in the fact that care for the elderly is a matter that is governed by the department of
Social Affairs and not by the Department of Health. In policy statements, mention
is only made that more attention will be given to the elderly, although the World
Health Organization (WHO) and the Pan American Health Organization (PAHO)
have urged for more awareness of the governments and provided guidelines for the
coming decennium in the area of health care for the elderly (Active Ageing: A Policy
Framework, April 2002)12.
Chapter 1 | General Introduction and Aims of this Thesis
23
1.3.2 History of care for the elderly in Suriname
The care for the elderly as has been developed during the last years has a very
definite history in Suriname.
In 1919, the government of Suriname started with a home for the elderly called
‘s Lands Weldadigheids Gesticht (LWG). The objective of this institution was to
provide accommodation and care to those, who had no relatives to take care of
them.
In 1980, LWG was closed because of its outdated and insufficient facilities, and
all residents moved to Huize Ashiana. At present, Huize Ashiana has about 350
residents, aged between 60 and 90 years.
1.3.3 The socio-economic position of elderly people in Suriname
In the past people, mostly coming from The Netherlands and especially working
for the government and the bigger firms and plantations in Suriname e.g.
administrative personnel and civil servants, had a lower life expectancy. Many
tropical diseases such as malaria, diphtheria, and cholera could often not be
effectively cured and were not under control yet. It was very normal that young
people died in the tropics. Because of that fact a regulation was made for those
people and the term ‘tropical years’ was established, for every year working in
the tropics (for instance Suriname) counted double when the person went back to
Holland. Reasoning for this rule was that working in the tropics meant working
harder and also in a harder environment. Rest after hard work was justified then
and people could retire at a lower age than people in the Netherlands, the age of
retirement now being 65 in the Netherlands while in Suriname being 60 years. When
Suriname got independent in 1975 this rule was still valid and the age of retirement
in Suriname is presently still 60 years (Landsverordening 1957)13.
At the age of 60 years a person becomes eligible for receiving an AOV (Algemene
Ouderdoms Voorziening i.e. General Old Age Pension), which in September 2008
stands at SRD 275 (US $ 100) per month14. To become eligible for this allowance, the
elderly person has to be registered at the AOV office of the Ministry of Social Affairs.
According to this office the total number of registered elder people as of July 1st 2005
stood at 39.232 of which 17.858 are men and 21.374 women. About 7% of the people
over 60 are not registered. This AOV allowance is considered far below the average
poverty line, which is about 350 SRD per month (about US $ 127) according to the
report Basic Indicators 2005-1 from the General Bureau of Statistics.
As in many countries in the world in Suriname ageing is traditionally considered
as a stage in life for slowing down, to retire, to be less active and to rest. The concept
of ‘rest after hard work’ is still in the way of thinking of many of Suriname’s people.
It is very normal to be passive if a person is getting older. Children will stimulate
their parents to be passive and sedentary when they have reached a certain age. ‘It is
time to rest now’, the parents have worked hard enough in their life. Even gardening
and housekeeping is sometimes not allowed. It is easier to hire somebody to do this
kind of ‘work’. The whole society accepts this approach.
Another example that illustrates this way of thinking is that the retiree often gets
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Ageing with joy
a rest chair as a present at his or her retirement. Most of the people also see the home
for the elderly as a rest home, a home where you can rest for the duration of your
remaining years.
As part of the elderly care in The Netherlands, there are special homes for the
elderly. Primarily those homes were created to be rest homes for the elderly who
have worked hard in their lives. The Surinamers who moved to Holland in the
eighties and nineties and left their parents in Suriname experienced the Dutch
solution of care for the elderly and it seemed to be logical to copy this concept in
Suriname and they strove to place their parents in this kind of homes.
1.3.4 The present situation of care for the elderly in Suriname
According to the directory published by the Ministry of Social Affairs15 there are
fourteen homes for the elderly in Suriname, of which ten are situated in Paramaribo.
The largest, Huize Ashiana, is fully funded and managed by the Ministry of Social
Affairs, which is also responsible for the training of the nursing staff of all homes.
The total number of residents in all homes is estimated at 1000 and of whom 900 are
originating from the greater Paramaribo area.
Officially there are no real nursing homes in Suriname but only homes for the
elderly where people at a certain age can be admitted when they are still healthy and
mobile and able to take proper care of themselves. In these homes they can stay the
rest of their lives even when they become chronically ill and invalid and then need
proper nursing care. The net effect for Suriname is then that all homes for the elderly
in reality are a mix of both types of care. There are however some homes which
function predominantly as nursing homes which will take mostly elderly who need
to be nursed. In this kind of homes the residents do not have to cook and do not
have to clean their rooms. Nurses and aids are there to take care of them. This will
stimulate the residents to be more passive and to be sedentary. There is one home,
Huize Margriet, where the majority of residents are more independent and selfreliant. They cook their own meal everyday, and they clean their own rooms. Those
residents are more active, do their own household, do their own shopping and are
more socially active.
Most of the personnel of these homes are not highly qualified or trained. Most of
them are trained as aids for the elderly. Sometimes there is only one qualified nurse.
The concept of ‘rest after hard work for the older people’ is also in their mind and
this will not bring them to stimulate the residents to be more active. They also see the
homes as a place for the elderly to rest, where there is no physical activity possible.
It is their job to give as much as possible all the care to the elderly. Because this way
of thinking about their job in the homes there is always too much work to do and
there is constantly a lack of trained personnel. They are not used to the concept that
resting and relaxing do not have to mean to be less active and should be trained in
the idea that gardening or walking can be also relaxing.
The concept of active ageing, as formulated by the WHO in their document
‘Active Aging: A Policy Framework’ (2002)12, also involves social activity as well as
participation in the community in which the elderly stay. This concept is as yet not
Chapter 1 | General Introduction and Aims of this Thesis
25
very much adopted by most of the personnel taking care of the elderly in Suriname.
They are generally of the opinion that a rest-home is a prior stop to the cemetery. The
elderly have to spend their last years of their life in such a home, resting and waiting.
The Surinamese society is as yet not very much aware how important the
environment can be. Not only the staff and other personnel that surround the elderly
in those last days, but the localization of the home is even important. Environment
of the homes can be very discouraging to be physically active. A home that is build
next to a cemetery, with a view to that cemetery is not stimulating to live. It will
make people sad and depressed. The presence of many stairs or the non-functioning
of the solitary elevator is not stimulating nor for the staff neither for the residents to
walk. Well maintained walking paths in a nice garden with many blooming flowers,
with benches in the shades, will stimulate people to walk and be more active.
All homes for the elderly have occasional activities to stimulate social contacts.
Those activities involve mostly playing bingo and handicraft-classes. In general
however the attitude prevails that old age deserves rest especially rest in physical
sense. A number of initiatives were undertaken to incorporate physical activity in
the programmes for the elderly residents. This is done more on a voluntary basis and
initiated by the residents as well as the trainer and has no structural implications.
Given their status of independence and self-reliance a few residents of those homes
are doing some gardening, in addition to their household activities. As yet there is
no structural policy to promote an active lifestyle as has been urged by the WHO
and PAHO in accordance with the trend in the developed countries.
1.3.5 Homes for the elderly; ethnical and religious differences
According to the directory of the Ministry of Social Affairs of Suriname there are,
as mentioned above, fourteen homes for the elderly in Suriname. Most of these
homes are managed by religion groups; there are Roman Catholic, Protestant,
Muslim, and Hindu homes. Because of the fact that religion is related to some
ethnicity, the residents and the management are from a certain ethnical group. For
example a Hindu home for the elderly will have a Hindustani management and all the
residents will be also from the Hindustani ethnicity. Muslim homes have either
Javanese management with Javanese residents or Hindustani management with
Hindustani elderly. The Christian homes have ethnically speaking a mixed population.
The ethnical groups in Suriname deal differently with physical activity,
depending on their different cultures, gender, and sometimes even their religion.
One can expect the participants of different ethnicities to respond differently
to exercise programmes, although this can not be certain on the beforehand.
A bias can be expected here however because of the differences in the various
homes in the ethnicity as well as in the age and also in the social strata the residents
of the homes are originating from.
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Ageing with joy
Part 2 Health, Fitness and Physical Activity
1.4 Definitions
1.4.1 Health
The World Health Organization (WHO) defines health in its Constitution as ‘a state
of complete physical, mental and social well-being and not merely the absence
of disease or infirmity.’16 At the International Consensus Conference on Physical
Activity, Physical Fitness, and Health, in Toronto2 health was defined as ‘a human
condition with physical, social, and psychological dimensions, each characterized
on a continuum with positive and negative poles. Positive health is associated with
a capacity to enjoy life and to withstand challenges; it is not merely the absence
of disease. Negative health is associated with morbidity and, in the extreme, with
premature mortality.’ Both definitions of health acknowledge the importance
of the physical and the psychological components as well. Both emphasize the
effect of the surrounding environment on the individual person, e.g. the effect of
society, the effect of different cultures, ethnicity, climate, habitat, and religion on the
person and visa versa. What may be normal and completely acceptable in one society
may be absolutely wrong in another. Then there are also the racial differences which
together with the cultural ones may make even neighboring countries totally
different from each other with respect to the concept of health. Even gender may
lead to these differences. This necessitates to take into consideration a lot of factors
which hitherto have only been discussed in a very limited way in relation to health.
1.4.2 Fitness
The terminology of fitness has been interpreted differently. For this study however
it is necessary to use the term of physical fitness. In the western world fitness is
often associated with health. The terminology ‘fitness’ is normally used to describe
the suitability or the competency of the physical condition and has a subjective
character; one cannot measure fitness in itself. Physical health is often compared
with physical fitness and the latter has been defined in many ways. However, a
generally accepted approach is to define physical fitness as ‘the ability to carry out
daily tasks with vigor and alertness, without undue fatigue, and with ample energy
to enjoy leisure-time pursuits and to meet unforeseen emergencies.’17 The WHO
defined physical fitness as ‘the ability to perform muscular work satisfactorily.’16
This implies that the individual has attained those characteristics that permit a good
performance of a given physical task in a specified physical, social, psychological
and spiritual environment.
Physical fitness relates to many different physically measurable factors such as
body composition, reaction time, agility, balance, skeletal muscular power, speed,
flexibility, and cardio-respiratory endurance. Physical fitness is a set of these
Chapter 1 | General Introduction and Aims of this Thesis
27
attributes that people have or achieve that relates to the ability to perform physical
activity.2 Because these attributes differ in their importance to athletic or physical
performance versus health, a distinction has been made between performancerelated fitness and health-related fitness18,19. Performance-related fitness refers to
components, which are necessary for optimal work and sport performances. It is
defined in terms of the individual’s ability in athletic competition, a performance
test, physical endurance or occupational work. Physical fitness as associated
with performance and health, depending on age and health status has also been
studied by Lemmink20. For healthy young people with the normal daily demands of
occupational work and sport, physical fitness is associated with performance, while
for inactive middle aged adults and adults with health problems this is associated
with health. For the elderly fitness is associated on the one hand with adequately
executing and maintaining (instrumental) activities of daily living ((I)ADL) and on
the other with health. ADL are activities which are the basics of daily functioning e.g.
dressing, washing, getting up from a chair, transferring over a short distance, eating
and drinking. IADL are activities, more complex than ADL, which are executed
in relation with the environment e.g. shopping, gardening, cycling, and using the
public transportation. Health is related to preventing and limiting health problems.
Adequately executing and maintaining (I)ADL and health affects each other and
both are of great importance for the extent of independency and the quality of life of
the elderly. In this context motor fitness, which term has been coined for the first time
by Lemmink, of the elderly refers to motor suitability or competency for executing
and maintaining physical activity which are important for independent functioning
in daily life.
Performance-related fitness depends heavily upon body size, body composition,
motivation, nutritional status, motor skills, muscular strength, power or endurance,
and cardio-respiratory power and capacity. In general and in contrast to popular
thinking, performance-related fitness shows only a limited relationship to health.
Although a good health must be a prerequisite to perform especially in manual
labor. Physical fitness to optimally perform in daily life in the elder person can also
be defined as performance-related fitness.
Health-related fitness refers to those components of fitness that are affected
favorably or unfavorably by habitual physical activity and related to health status. It
has been defined as a state characterized by
a) an ability to perform daily activities with vigor and
b) a demonstration of traits and capacities that are associated with a low risk
of premature development of hypo kinetic diseases and conditions. This includes
morphological (e.g. body composition, subcutaneous fat distribution, abdominal
visceral fat, bone density, flexibility), muscular (e.g. power, strength, endurance),
motor (e.g. balance, coordination), cardio-respiratory (e.g. blood pressure, maximal
aerobic power and capacity, heart and lung function) and metabolic fitness
components (e.g. glucose and insulin metabolism, blood lipid and lipoprotein
profile, and the ratio of lipid to carbohydrate oxidized in a variety of situations)21.
Motor fitness of the elderly was defined by Lemmink as ‘the degree that
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elderly people command over those motor characteristics (motor aptitude) that
are necessary for executing and sustaining motor activities in daily life.’20 He used
the same aforementioned dimensions and selected coordination, reaction time, and
equilibrium as components of the motor dimension, strength as a component of the
muscular dimension, flexibility as a component of the morphological dimension,
and aerobic endurance as a component of the cardio-respiratory dimension.
Coordination, reaction time, equilibrium, and flexibility primarily affect the ability
to execute motor activities, whereas strength and aerobic endurance also relate to the
ability to sustain motor activities in daily life.
1.4.3 Physical activity
Physical activity, defined as ‘bodily movement produced by the contraction of
skeletal muscle that increases energy expenditure above the basal level’17, is generally
accepted as relevant to health.
Physical activity can be categorized in various ways e.g. type, intensity, and
purpose, depending on the context in which it occurs. Common categories include
occupational, household activities, leisure-time physical activities, transportation
and other chores e.g. playing with children or nursing elderly relatives. Leisuretime activity is described by Stevens22 as an activity undertaken in the individual’s
discretionary time that leads to any substantial increase in the total daily energy
expenditure and can be further subdivided into categories such as competitive
sports, recreational activities (e.g., hiking, cycling), and exercise training. However,
there are wide inter-individual variations, depending partly upon such personal
aspects as age, the duration of paid work and the amount of household activities.
The terms ‘physical activity’ and ‘exercise’ or ‘exercise training’ have been used
synonymously in the past. However, exercise has been used more recently to denote
a subcategory of physical activity: ‘physical activity that is planned, structured,
repetitive, and purposive in the sense that improvement or maintenance of one or
more components of physical fitness is the objective’19.
Exercise training also has denoted physical activity performed for the sole
purpose of enhancing physical fitness17. While physical activity may lead to general
fitness of the individual and his or her body exercise will only lead to fitness specific
to the particular exercise and for a certain purpose.
1.4.4 Quality of life
In 1994 the WHO12 defined ‘quality of life’ as ‘an individual’s perception of his or her
position in life in the context of the culture and value system where they live, and
in relation to their goals, expectations, standards and concerns. It is a broad ranging
concept, incorporating in a complex way a person’s physical health, psychological
state, level of independence, social relationships, personal beliefs and relationship
to salient features in the environment.’ As people age, their quality of life is largely
determined by their ability to maintain autonomy and independence.
One can discern that quality of life is closely related to the concept of health
as defined by the WHO. Both have many factors in common by which they are
Chapter 1 | General Introduction and Aims of this Thesis
29
influenced and both are in reality perceptions of the individual.
To test these perceived aspects a number of questionnaires have been developed
in the course of time by many different authors. Also for the elderly these
questionnaires have been used to evaluate their health status in physical sense as
well as in psychological as psychomotor sense. In chapter 3 we will deal extensively
with the questionnaires used in this study.
1.5 Relationships between physical activity, health-related fitness
and health
Under the title: ‘Sedentary lifestyle: a global public health problem’ the WHO23
published the following statement:
‘Sedentary lifestyle is a major underlying cause of death, disease, and disability.
Approximately 2 million deaths every year are attributable to physical inactivity; and
preliminary findings from a WHO study on risk factors suggest that sedentary lifestyle is
one of the ten leading causes of death and disability in the world. Physical inactivity increases
all causes mortality, doubles the risk of cardiovascular disease, type II diabetes, and obesity.
It also increases the risks of colon and breast cancer, high blood pressure, lipid disorders,
osteoporosis, depression and anxiety.
Levels of inactivity are high in virtually all developed and developing countries. In
developed countries more than half of adults are insufficiently active. In the rapidly growing
large cities of the developing world, physical inactivity is an even greater problem. Crowding,
poverty, crime, traffic, low air quality, and a lack of parks, sports and recreation facilities, and
sidewalks make physical activity a difficult choice.
Even in rural areas of developing countries sedentary pastimes, such as watching
television, are increasingly popular. Inevitably, the results are increased levels of obesity,
diabetes, and cardiovascular disease. In the entire world, with the exception of sub-Saharan
Africa, chronic diseases are now the leading causes of death. Unhealthy diets, caloric excess,
inactivity, obesity and associated chronic diseases are the greatest public health problem in
most countries in the world.
Data gathered on health surveys from around the world is remarkably consistent. The
proportion of adults who are sedentary or nearly so ranges from 60 to 85%.
WHO is currently assessing the global burden of disease from 22 health risk factors,
including physical inactivity. The results of this research will be published in the World
Health Report 2002. It is clear that physical inactivity is a major public health problem that
affects huge numbers of people in all regions of the world. Effective public health measures are
urgently needed to promote physical activity and improve public health around the world.’
The conclusion of this statement is that physical activity is very important in
daily life and has definite relations to public health in general and health in each
individual. Regular physical activity, combined with adequate diet has shown to
be one of the most effective means of controlling mild to moderate obesity and
maintaining an ideal body weight in women. In women as it is for men physical
activity is very important to prevent illnesses and disability especially since
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in women it can also greatly help prevent and manage osteoporosis. Women,
particularly post-menopausal, have a higher risk of developing osteoporosis than
men. Weight-bearing activities such as walking, dancing and jogging, is essential
for normal skeletal development in the childhood and adolescence, and may help in
decreasing bone loss. It also improves muscle strength and balance and reduces the
risk of falling, thereby helping to prevent fractures.
At the International Consensus Conference on Physical Activity, Physical Fitness,
and Health, held in 1988 in Toronto a basic model was used to specify the relationships
between physical activity, health-related fitness, and health2. This model, also known
as the Toronto Model (see Figure 1.11), specifies that habitual physical activity can
influence fitness, which in turn may modify the level of habitual physical activity.
Figure 1.11 The Bouchard or Toronto model, describing the relationships between habitual
physical activity, health-related fitness, and health status
With increasing fitness for instance, people tend to become more active while the
fittest individuals tend to be the most active. The model also specifies that fitness
is related to health in a reciprocal manner. Fitness for instance not only influences
health, but health status also affects both habitual physical activity level and fitness
level as well. Other factors are also associated with individual differences in health
status. Likewise, the level of fitness is not determined entirely by an individual’s
level of habitual physical activity.
Other factors can also affect physical activity, fitness, and health. Four types of
influence are important: lifestyle behaviors, personal attributes, physical and social
environment. Lifestyle comprises the aggregate of an individual’s actions and
behaviors of choice which can affect health-related fitness and health status.
Habitual physical activity is one such behavior over which the individual has
a large measure of voluntary control. Several personal attributes, e.g. age, gender,
socioeconomic status, personality characteristics, and motivation, shape the lifestyle
pattern of a person, including the attitude toward physical activity and other healthy
habits. Physical environmental conditions, e.g. temperature, humidity, air quality,
Chapter 1 | General Introduction and Aims of this Thesis
31
altitude and climatic changes, can affect participation in leisure time physical
activity, fitness level, and health status. Such conditions influence not only the ability
to exercise, but also the physiological response to the demands of exercise. Finally
social environment may be defined as the combination of social, cultural, political,
and economic conditions that affect participation in physical activity, health-related
fitness, and health status. Social networks, e.g. members of the family, other relatives,
friends, social clubs, church organizations, and other groups, may have a positive
influence on attitudes toward physical activity and other healthy behaviors. They
are all part of the social milieu that can affect both health and the sense of well-being
of an individual.
The WHO (2005)24 stated that the health benefits of regular physical activity are
many. At least 30 minutes of moderate physical activity, for example brisk walking,
is enough to bring many of these effects. However, by increasing the level of activity,
the benefits will also increase.
‘Regular physical activity:
1. reduces the risk of dying prematurely
2. reduces the risk of dying from heart disease or stroke, which are responsible for
one-third of all deaths
3. reduces the risk of developing heart disease or colon cancer by up to 50%
4. reduces the risk of developing type II diabetes 50%
5. helps to prevent / reduce hypertension, which affects one-fifth of the world’s adult population
6. helps to prevent / reduce osteoporosis, reducing the risk of hip fracture by up to 50% in women
7. reduces the risk of developing lower back pain
8. promotes psychological well-being, reduces stress, anxiety and feelings of depression and loneliness
9. helps prevent or control risky behaviours, especially among children and young people, like tobacco, alcohol or other substance use, unhealthy diet or violence
10. helps control weight and lower the risk of becoming obese by 50% compared to people with sedentary lifestyles
11. helps build and maintain healthy bones, muscles, and joints and makes people with chronic, disabling conditions improve their stamina
12. can help in the management of painful conditions, like back pain or knee pain
We all know that physical activity - taking a walk, riding a bike, dancing or playing, even
gardening - simply makes you feel better. But regular physical activity brings about many
other benefits. It not only has the potential to improve and maintain good health, but it can
also bring with it important social and economic benefits.
Regular physical activity benefits communities and economies in terms of reduced health
care costs, increased productivity, better performing schools, lower worker absenteeism
and turnover, increased productivity and increased participation in sports and recreational
activities.
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In many countries, a significant proportion of health spending is due to costs related
to lack of physical activity and obesity. Promoting physical activity can be a highly costeffective and sustainable public health intervention’.
1.6 Physical fitness and ageing
Generally spoken ageing and a decline of motor fitness go hand in hand. This decline
partly is natural: the primary ageing process. On the other hand the decline of motor
fitness is also based on a lifestyle which is characterized by a less versatile and less
intensive physical activity, and on the deterioration of health: the secondary ageing
process. Less versatile and less intensive physical activity partly comes into being by
a natural decrease and partly because of the less demands of daily life. Deterioration
of health develops by a progression of degenerative diseases with ageing: the socalled old-people’s diseases.
As people age, their quality of life is largely determined by their ability to
maintain autonomy and independence. Loss of physical activity will automatically
lead to diminished fitness, as follows from the Toronto model, which in turn will
have negative effects on health and which in turn will lead to accelerated loss of
activity by which the circle closes. This will give rise to a passive and sedentary way
of life.
‘Active ageing’ a term adopted by the WHO23 in the late 1990s is the process of
optimizing opportunities for health, participation and security in order to enhance
quality of life as people age. This process will be elaborated upon in this thesis and
forms the basis of the study.
The word ‘active’ refers to continuing participation in social, economic, cultural,
spiritual and civic affairs, not just the ability to be physically active or to participate
in the labor force. From the Toronto model it follows that we have to stimulate active
ageing through health related fitness by physical activity which is in reality part of
the process of active ageing as it will contribute to better wellbeing and improved
health and thus quality of life.
In Chapter 2 we will enter into this subject to a greater extent and we will show
how the physical fitness in elderly people can be influenced in a positive way by
physical activity programmes as described in the next paragraph, which has been
cited from the WHO25 publication 2005.
‘For people of all ages, physical activity improves the quality of life in many ways.
Physical benefits include improvement of balance, strength, coordination, flexibility and
endurance. Physical activity has also shown to improve mental health, motor control and
cognitive function.
Active lifestyles provide older persons with regular activities to make new friendships,
maintain social networks, and interact with other people of all ages. Improved flexibility,
balance, and muscle tone can help prevent falls - a major cause of disability and chronic
illness among older people. It has been found that the prevalence of mental illness is lower
Chapter 1 | General Introduction and Aims of this Thesis
33
among people who are physically active.
The benefits of physical activity can be enjoyed even if regular practice starts late in life.
While being active from an early age can help prevent many diseases, regular movement and
activity can also help relieve the disability and pain associated with these conditions.
Physical activity can also contribute greatly to the management of some mental disorders
such as depression and Alzheimer’s disease. Organized exercise sessions, appropriately suited
to an individual’s fitness level, or simply casual walks can provide the opportunity for making
new friends and maintaining ties with the community, reducing feelings of loneliness and
social exclusion. Physical activity improves self-confidence and self-sufficiency - qualities
that are the foundation of psychological well-being.
As for people of all ages, older persons should take part in physical activities they enjoy
the most. Anyone with a specific condition or disability that could affect their ability to be
physically active should seek the advice of a doctor before participating in physical activity.
Walking, swimming, stretching, dance, gardening, hiking and cycling are all excellent
activities for older persons.
The number of people over 60 years old is projected to double in the next 20 years. Most
of these older persons will be living in developing countries. Reducing and postponing agerelated disability is an essential public health measure and physical activity can play an
important role in creating and sustaining well-being at all ages.’
1.7 The development of physical activity programmes
People everywhere in the world, in both industrialized and developing countries,
are living longer. Progresses have been made in the field of public health, hygiene,
medical technology, and environmental conditions. However, at the same time there
is a large increase of non-communicable diseases (NCDs) which are mostly chronic
illnesses, especially seen in the ageing populations, combined with the increasing
numbers of people who are victims of lifestyle problems such as exposure to
tobacco and other risk factors, for instance obesity, physical inactivity, and alcohol
consumption. It is therefore clear that unless vigorous measures are taken to prevent
NCDs commonly associated with the aging process this will inevitably place new
and increased demands on health care systems. The challenge will be to implement
public policies, strategies, and interventions that provide both collective and
individual incentives and disincentives to change risky behaviors and reduce the
risks of NCDs as people age.
In 1992, the General Assembly of United Nations (UN) declared 1999 to be the
International Year of Older Persons (IYOP). To celebrate this and to promote the
Global Movement for Active Ageing, WHO launched a campaign on World Health
Day 1999 with the slogan ‘active aging makes the difference.’ The aim of the Global
Movement was to launch new and innovative activities in the areas of advocacy
and policy development to prevent functional decline in aging populations and to
promote healthy and active aging.26
In his lecture titled ‘A Retrospective Analysis of International Initiatives and
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Ageing with joy
Programmes In Response to the International Year’ as published by the International
Federation of Sports Medicine (FIMS) in conjunction with World Health Organization
(WHO) Sidorenko gave an overview of the many international initiatives that were
organized in response to this International Year of Older Persons in 1999 (Active
Aging, 2002).27
The definition of active aging is guided by the definition of health as laid down
in the WHO Constitution and refers to ‘the process of seizing and maximizing
opportunities for mental, physical and social well-being throughout the life course
to increase healthy life expectancy and quality of life at older ages.’
More than eighty countries developed national action plans to celebrate this
international year. Building on the World Health Day slogan of ‘active aging makes
the difference’ and the launch of the Global Movement for Active Ageing, the Global
Embrace, a walk event and celebration that encircled the globe on October 2, 1999,
celebrated healthy and active aging in a visible, creative way that was attractive to
both older and younger people.
It is estimated that over 1 million people in 96 countries participated in about
3000 walks all over the globe on that day.
Numerous conferences, congresses, and strategic planning initiatives were
organized. Most of the worldwide activities for the Year were condensed into the
4 facets of the conceptual framework for A Society for All Ages :
1. the situation of older persons,
2. lifelong individual development,
3. multigenerational relationships, and
4. population aging and development.
In addition, initiatives in the area of women and aging were also highlighted.
However, no mention was made of initiatives into the development of structural
active living programmes, let alone programmes that promote physical activity,
whereas in Europe the benefits of physically-active lifestyles for health were the
subject of the 4th International Congress on Physical Activity, Ageing and Sports
(Heidelberg, Germany, August 1996)28 during which the ‘Heidelberg Guidelines for
Promoting Physical Activity Among Older Persons’ were adopted. The Guidelines
clearly refer to the age of 50 years as the point in middle age at which the benefits of
regular physical activity can be most relevant in preventing or reversing many of the
physical, psychological, and social risks that accompany older ages.
In the Netherlands too physical inactivity of the population used to be very
common. In 1992 the Dutch Heart Foundation published its first report on physical
inactivity as an independent risk factor for cardiovascular disease. The Foundation
acknowledged that new policies and strategies had to be developed in order to
stimulate people to be more physically active. Physical activity has been promoted
on a large scale in different lifestyle campaigns by both the Foundation and the
Dutch government. However, little or no structural study has been done into the
effectiveness of lifestyle and physical activity promotion campaigns.
In 1999 the Groningen Active Living Model (GALM), a new behavior change
Chapter 1 | General Introduction and Aims of this Thesis
35
strategy to stimulate leisure-time physical activity, was introduced by Stevens et al.29
The GALM strategy aims to stimulate and monitor sedentary older adults who are
willing to participate in leisure-time physical activity. The authors showed that this
strategy was feasible and could be implemented in the Netherlands on a large scale
basis.
They also formulated the fundamentals of the application of theoretical models on
practical situations by improved strategies thus paving the way for the incorporation
of this kind of a programme into the structure of the society as a whole.
‘Improved strategies :
1. New strategies should be based on theoretical models rather than pragmatic principles.
In the Netherlands, past behavioral change interventions have lacked a theoretical basis.
In a theoretical model, the underlying theory of operations and its effects can be revealed.
This leads to a better theoretical understanding of behavior in the long run, and provides
a firmer foundation for more effective interventions.
2. The stimulation strategy must be based on a behavioral change model specifically
designed to explain behavioral change in relation to becoming and remaining active
in leisure-time physical activity.
3. The theoretical model should be multidimensional. Several studies have already
indicated that no single variable or small set of variables can be considered the
primary determinant of leisure-time physical activity. It is rather a wide variety
of variables that have been shown to significantly correlate with or predict leisure time physical activity.
4. The new theoretical model should be dynamic. Prochaska and DiClimente’s stages of-change model, Sallis and Hovell’s theory about the natural history of exercise, and
Biddle and Mutrie’s resumption theory all show that becoming and remaining
physically active is a time-consuming and dynamic process of behavioral change. We
may thus conclude that a process-based model approach is required in order to
understand how people change over time. From this perspective, changes in health
behavior are viewed as cyclical rather than linear sequences of events.
(Stevens, 2001).’
One can see that these strategies are based on several subsets of properties in
order to make them more amenable to daily living. One can wonder whether they are
applicable to societies other than the Netherlands and could be used in developing
countries to effectively introduce similar programmes for the elderly.
In view of the findings as mentioned in Part 1 and the theoretical considerations
in Part 2 we set out to study the influence of physical activity programmes on the
health, physical fitness and wellbeing of senior citizens in Suriname and formulated
our intentions on this matter in the next paragraph which deals with the aims of this
study.
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1.8 Aims of this thesis
Considering the discussion so far we come to the conclusion that it is worthwhile
to conduct a study to determine the effects of activity programmes in homes for the
elderly on the health status of the growing number of elderly people in Suriname, a
developing country.
1. Will such programmes as applied in a structured setting have an influence
on the health of the population of the homes for the elderly in Suriname
and lead to an enhanced sense of physical and mental wellbeing?
2. Will there be differences between the different ethnic groups?
3. Will the application of such programmes lead to amore active lifestyle of the
elderly in such homes in Suriname?
Chapter 1 | General Introduction and Aims of this Thesis
37
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