The psychology of exercise in retirees
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This one is from The Psychology of Exercise by Josephine Perry.
As we age and move into our later years, we begin to evaluate our lives, develop greater awareness over the deterioration of our physical health and fear that we will soon need to depend upon others. Those in this stage of life can use exercise to extend their years of active independence, reduce disability and improve their quality of life. High levels of physical functioning are so fundamentally important to healthy aging that participation in exercise and physical activity is a strong predictor of aging well and a protector from some of the stress of the life events that we experience as we age.
The cognitive benefits found in exercise at younger ages still apply for those who are retired. Exercise at this age will still lead to improvements in executive function and cognitive performance, and there are also a growing number of studies looking at the impact of exercise on neurodegenerative health conditions. Studies are finding that physically active older people have a reduced risk of developing Alzheimer’s or other forms of dementia. It seems that exercise could be a powerful protective strategy against many of the health declines we tend to expect as we age.
Those joining programmes to improve their health find improvements in cardiovascular fitness, muscular fitness, psychological health, functional capacity and in their quality-of-life indicators. They reduce their levels of loneliness and isolation, have fewer depressive symptoms and find that the habit of regular attendance to a physical activity provides a sense of structure and purpose to their day-to-day lives, something particularly valuable for those recently retired from paid work. Even older people with major depressive disorder have been found to be able to reduce their depressive symptoms with aerobic and strength training.
Despite the numerous benefits, studies have found that as we go through the process of retirement, even though theoretically we have more time to exercise, we actually reduce the amount of physical activity we do. The theory of activity substitution suggests that as people retire, they should have more time to exercise as they gain leisure time. However, it seems there is still significant competition for time, especially around caring responsibilities. The more care that must be provided, the less physical activity is conducted and, as much of this care has fallen to women, it may be a factor in why exercise levels are lower in older women than older men.
The reduced physical activity levels are thought to come from less travel (mainly to and from work) and a lack of routine. Instead of compensating by increasing their leisure-time physical activity, it seems retirees are increasing the amount of time they are sedentary to, on average, 9.4 hours a day (Harvey, Chastin, & Skelton, 2015). It is estimated that the percentage of older adults meeting the recommendations on physical activity is around 22% (Grimm, Swartz, Hart, Miller, & Strath, 2012). Even physical activities such as walking decline significantly when people get to much older ages, and again, the decline is largest in women. This is thought to be a response to musculoskeletal problems and concerns about personal safety.
Positively though, studies have found that those who are about to or who have recently retired are receptive to changing their behaviours, feeling that retirement offers opportunities, specifically additional time, to develop a healthy lifestyle. If we are to use this opportunity as a platform for developing new exercise habits, we need to understand any barriers in place. This is not a simple process as the requirements, wants and influences of this group are complex, especially as in some countries such as the UK there is no longer a ‘retirement age,’ and so adults retire at different ages, with very different exercise histories. Understanding the psychology of exercise in those who are retiring and have been retired for some time will help those working in this area to support their physical activity needs effectively.
Barriers to Exercise in Retirees
Barriers, the significant potential obstructions to the adoption, maintenance or resumption of participation in exercise, can be extensive in retirement. Some barriers are fairly physical and need infrastructure support. Others are more perception led, health based, have a social focus or simply come from a place of inertia. Education, marketing and ease of access can help reduce these barriers. The final barrier is time. Despite retirees theoretically having more time to exercise, it is caring responsibilities, volunteer work and an enhanced social calendar that seem to prevent regular activity from being undertaken. Barriers from the logistical side are around the environment, and they can be extensive. Poor weather, darkness, uneven pavements, intimidating roads, buildings and parks, cars parked on pavements, air pollution, traffic, hills, fear of physical attack in a neighbourhood, fear of crime and a lack of suitable or affordable facilities for sessions nearby can all act as barriers to exercise. Most can be overcome, but it often takes significant effort on the part of the retiree to do so.
Perception issues can sometimes be approached through education. There are beliefs that exercise is too risky at an older age, that there will be discomfort or unpleasant sensations when exercising or that they are receiving conflicting health advice so are unsure of what to do, in which case less is easier and feels safer. There can also be perception issues caused by negative affect where feelings of depression, lack of motivation, reduced willpower or low discipline come into play. Here sometimes there will be links to low self-efficacy, particularly if not having exercised before. Feeling self-conscious, shy, embarrassed, intimidated or worried they won’t keep up or not having the right clothes or equipment can all prompt negative self-perception and an invisible but very real feeling barrier, particularly for women.
A significant number of retirees also have health issues which can make physical activity harder. Some of these may be caused by wear and tear, others by lack of fitness and some by chronic or acute illnesses which are more common as one ages. Some retirees who are actually highly motivated to exercise are stopped by injuries as they can occur more often at this age and can take longer to heal. This leaves them not only unable to exercise but also highly frustrated. As well as actual health issues, there can be the threat of health issues that may be prompted by exercise, such as fear of pain or shortness of breath, risk of injury or the fear of falling.
Facilitators of Exercise
Studies have found that there seem to be four main areas which influence retirees levels of exercise: personal factors (age, gender, education level, socio-economic class and time free), social and cultural factors (influence of a medical expert, social support and attitude of friends and family, social networks and expectations), environmental factors (type, location, and quality of physical activities; travel time; physical environment, home location and cost) and health (both real and perceived).
Gender can influence the amount of exercise undertaken by older people. There seem to be very different influences of exercise at this age based on gender. A study of 1,303 Finnish individuals aged 57–78 years found 39% of men and 48% of women were doing no moderate or vigorous leisure-time physical activity (Hakola, Hassinen, Komulainen et al., 2015). They found specific factors influencing exercise levels in men were age, marital status, still working, having a weak social network and poor diet. In women, cardiovascular disease and depressive symptoms were the key factors. Two large studies of female retirees in Australia found health and social contact were key to their exercise involvement.
Once adults are past retirement, the more they age, the more likely they are to drop exercise, except if they think of themselves as younger. This influence is based on perception around age and isn’t just about how old one perceives themself but their own attitude towards aging. A study of adults between the ages of 50 and 70 found that those who had positive aging expectations were more likely to engage in exercise and consume a healthier diet compared with those who had conventional aging expectations (Huy, Schneider, & Thiel, 2010). Those who assume that health problems are an inevitable consequence of growing old will feel preventive health behaviours (such as exercise) are futile and so do less. And really interestingly there can also be a feeling among a number of retirees that they feel high levels of sedentary behaviour are legitimate at their age, having ‘earned’ the opportunity to rest after decades of often intense and demanding employment.
Other personal factors which have been found to reduce the levels of exercise in retirement include lower levels of education and lower socio-economic status. Personality can also play a part, with those high in conscientiousness being more active.
Health issues are raised time and time again by participants in studies as influencing how much they exercise. Many of the issues involved are incredibly complex. For some they may act as a motivator and for others a barrier. One element where some generalisations can be made is that those who have poor general health (higher body weight, lower VO2 max, spending lot of time sitting, high depression scores and perceive their health is poor) are those doing the least physical activity. If an older adult believes they have the physical health in place to be active, this will positively influence the levels of activity they do, so self-efficacy can be considered to be a really strong indicator of exercise in this group.
The social environment and social support given, such as friends and family, have consistently been found to influence participation in physical activity in older age, but unfortunately older people generally receive less encouragement from others regarding their exercise habits, possibly because friends and family are nervous about risks.
A way to study where helpful social influence is coming from is to look at social networks. A social network is the collection of meaningful personal ties that individuals maintain, such as relations with family members, friends, neighbours and significant others. Supportive social networks have a positive impact on the maintenance of an exercise programme and on a physically active lifestyle. A study based on the data within the Baltimore Longitudinal Study on Aging (a survey of 6,780 respondents) found that physical activity is associated with having more social-support networks outside of the family (Wolinsky, Stump, & Clark, 1995), and it is those with really diverse social networks who have the highest levels of physical activity.
A wider cultural issue is that retirees can feel excluded and like a ‘forgotten group’ where nothing is tailored for them. They feel too old for regular exercise programmes and too young for ones focused on older people.
Finally, the environment around retires can either act as a strong enabler of physical activity or a significant block to it. Several studies have found that one of the highest enablers of exercise was having walkable access to amenities; this is important because walking is the main exercise for many older adults. Convenience is also important, with activities being offered closer to home leading to more active lives. Higher levels of physical activity in the community are under- taken when the pavements and gardens are well maintained, when there is less litter, when there is seating, green spaces and accessible locations to exercise. Levels of exercise go down when there are window security bars on residences and high neighbourhood violent-crime rates. This has been found to link to why those in lower socio-economic groups do less exercise; they feel unsafe doing physical activity in their neighbourhoods and have less access to facilities either due to availability or cost.
The Motivations of Retirees to Exercise
Understanding exactly what motivates people to become physically active is a key factor in designing effective exercise interventions, and there are some specific studies that can help us understand the strengths of some of these motivators on retirees.
A systematic review of nearly 2,000 participants identified 92 motivators to older people participating in resistance training (Burton et al., 2017). The most frequently identified reasons for commencing and continuing resistance training were health related, but there were also key motivators around longevity and being able to live independently. A French study looking at 92 physically active retirees aged between 63 and 89 backed up this health element, splitting their responders into two groups: those who see physical activity as a high priority to stay healthier longer, to take care of their body and mind and to maintain physical autonomy; and those who come from a risk perspective, using physical activity to prevent falls and fractures and delay the onset of physical frailty (Ferrand, Nasarre, Hautier, & Bonnefoy, 2012).
Interestingly, for studying retirement, age plays a part in motivation to participate in exercise. The middle-age group (55–64) in a study by Kolt, Driver, and Giles (2004) differed significantly in their reasons for participating in exercise to those older than them. They rated social, fitness and challenge reasons significantly higher than participants in any other age group. The ‘old-old’ group (those over 75) rated medical reasons higher than anyone else.
Even when highly driven to turn motivation into activity, it needs to be easy for people to exercise. Having access to good-quality, cost-effective exercise facilities, activities and equipment, in a convenient location, close to home, staffed by competent professionals with retiree-relevant expertise who are friendly, interactive and encouraging is necessary. Within this it is key there is some element of choice, such as being able to exercise at their own pace, in sports or classes which they enjoy, at a level which is neither too easy nor too advanced for their personal situation and doesn’t feel intimidating.
A social side is also important for many. A French study found that when exercising with others, the participants saw it as not only a group activity but also a place where they can meet and communicate with others sharing their experiences (Ferrand et al., 2012). Some used this group for support, others for motivation. If there is a sense of belonging, a feeling they fit in a way to grow friendships while exercising, a sense of vicarious confidence by seeing others like them being active and having a good and non-threatening gym or exercise atmosphere, then retirees feel accepted and engaged. They will want to continue to stay physically active. This social side can then become the glue that binds together the exercise and the exerciser.
Processes to Get Retirees Exercising
The moment of retirement could be an ideal stage for implementation of interventions which prevent older adults from lapsing into an inactive lifestyle and from becoming socially excluded. However, with the depth and range of barriers that exist, proactive engagement is required to help older adults find their motivation so they can alter their behaviours to become more active.
A key area for increasing engagement with retirees around the importance of including physical activity in their lives can come through education, specifically the dissemination of accurate information to counter misperceptions such as fear of falling or believing the guidelines for physical activity (150 minutes a week) are too physically demanding and beyond their capabilities. It has been suggested that meetings or booklets are given to adults on retirement to explain the guidelines, the benefits in following them and what motivates others to exercise in case this inspires and offers help in identifying opportunities to achieve more physical activity themselves.
Simply disseminating information about the health benefits of moderate physical activity is not sufficient to increase participation. Instead, working on boosting a retiree’s self-efficacy has been found to increase increased exercise participation. It has a circular effect, too, with those who exercise more frequently and who have social support throughout an exercise programme increasing their levels of self-efficacy.
Another element to get retirees exercising can be around highlighting ease of access into physical activity. A large number of studies from a wide range of countries have focused on walking as the most common form of exercise, and others have shown that even a small increase in walking can have significant health benefits. Perhaps a focus on using this method to reach the advised 150 minutes a week will help to get retirees building better exercise habits, and once this is in place, they will have increased their self-efficacy and can add more vigorous exercise into their schedule.
Increasing Adherence Once Exercising
Group-based physical activity has been found to be an excellent way to start a physical activity programme, but long-term adherence rates are actually greater in those who engage in individual exercise. In a US study of 3,305 adults, it was clear that older adults and retirees had a strong preference (69%) to exercise alone with some instruction rather than being in a formal group with an exercise leader (Wilcox, King, Brassignton, & Ahn, 1999). Perhaps this is because although older adults prefer a group setting, their activities will be less personalised with this approach, and being able to tailor exercise programs to the needs and interests of participants allows them to initiate and maintain a routine of regular physical activity.
Social support has been found to be both a barrier (when some push for their older family members to take life easier or have caring responsibilities) and a motivation (through exercise buddies, active family and friends or health-education support). Using social support effectively could make adhering to exercise much easier for retirees. One way to achieve this can be through peer mentoring. It is based on the idea that individuals who share common problems have a unique resource to offer one another and that with training and supervision, they can help others. Among older adults, peer mentors have been reported to be empathic and respectful towards one another and through positive role modelling have been found to be able to not only dispel some of the negative stereotypes of aging but also empower participants. When one study investigated the effectiveness of a peer-mentored exercise program on 60 older adults (mean age 69), they found those who were peer mentored improved their fitness significantly and by just as much as those mentored by younger fitness experts.
Something else being trialled is health contracts. A health contract usually includes realistic goal setting and a measurable plan or course of action agreed between the retiree and health professional for reaching health goals. Tools like calendars can be used to record physical activity and help the retiree monitor how well they are doing and reinforce their commitment. Alongside this can be positive reinforcement through social recognition for improvement or success and regular performance feedback. Providing regular and accurate performance feedback can help older adults develop realistic expectations of their own progress. It helps them develop self-efficacy and feelings of competency, both elements which will help them maintain their exercise routine. Feedback needs to be positive, meaningful and offer further direction for the retiree to continue to improve.
Finally, knowing the risk factors for dropout can be valuable as pre-emptive action. A number of risk factors can be identified as to who may drop out of exercise programmes. Dropout levels are often high, with some reporting retention rates as low as 54% (Caserta & Gillett, 1998) and mainly occurring during the first three months of a programme. This means efforts need to be made to address these risks early on in any intervention. Even after completing a programme, some studies have found that within two years, most interventions to increase exercise in older adults around the age of retirement (55–70 years) had lost their effectiveness. At highest risk of dropout are those who are overweight, on a vigorous physical activity programme, fail to meet their goals early on, are from areas of lower socio-economic status, who are lonely and have low education levels. Taking each of these elements into consideration up front when setting anything up will ensure specific needs are considered.
Silverfit is a charity designed to promote happier, healthier aging by offering exercise sessions and social activities to those who have retired. They offer 17 activities (such as BMX biking, walking football, Pilates, badminton and cheerleading) in 15 locations in London. The sessions are low cost (£12 a year membership and £0–£3 per session) and involve around an hour of physical activity followed by refreshments in the café. Their research shows their sessions improve quality of life and save health and social care providers money through fewer doctor visits, reduced use of medication and less loneliness.
One of Silverfit’s members is 68-year-old Helen. Her story is typical. Before retiring she was so busy with caring for her children and her mother and doing her full-time job that fitting in exercise was really difficult. After retiring she realised how stressed she had been and wanted to try something completely different. Through Silverfit she tried badminton, something she hadn’t done since school.
Over the three years she has been attending, she has added activities, grown in confidence and made new friends. “After I stopped work I lost a stone and a half. It came from not snacking and being more active because at work I was really just sitting down all the time at a computer.
“When I first started badminton I couldn’t hit the thing but the instructor was so good and helped us take things on. I’ve definitely learnt a lot. I didn’t want to be social – I didn’t want to come and drink coffee afterwards – I just wanted to play my game but I suddenly thought my gosh, I’ve now got all of these people I can now go and play badminton with and I wouldn’t have known any of them if I hadn’t have had Silverfit.
“At badminton I met the lady who does the Nordic walking. And I joined one of her groups so I learnt Nordic walking that way, so I can just take myself off and that got me into doing a bit more walking which is good. In the future I want to do longer walks. There is a whole heap of places I want to go visit.
“I also do Tai Chi on a Saturday morning. When I started it was a council Adult Education class but they stopped funding it so we turned ourselves into a community group and we’ve managed to keep going. Tomorrow I’m trying a Pilates class. Without this I feel I could just drift on, and drift is not good. Because you turn round and you’ll be 85 and you think ‘damn – what did I do with all those retirement years?’
“I do wonder if I would have felt able to do that if I hadn’t have had the Silverfit background and getting to know people. I’ve got friends but they are fairly scattered and it is a whole different scene when you are not working. If you go out to work you’ve got your work colleagues there and even if it is just ‘hi, how are you doing today.’ When you stop working you lose your peer group. I think now I am more up for things like exercise since I retired as I realise: ‘sod it – what is the worst that could happen.’ You’ve only got one life.”
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