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The secrets of highly active older adults
Thea Franke a,⁎, Catherine Tong a, Maureen C. Ashe a,b, Heather McKay a,b,Joanie Sims-Gould a,b, The Walk The Talk Team1
a Center for Hip Health and Mobility, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canadab Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
a r t i c l e i n f o
⁎ Corresponding author at: Center for Hip Health andStreet, Vancouver, BC, V5Z 1M9, Canada. Tel.: +1 604 8
E-mail address: [email protected] (T. Fran1 The Walk the Talk Team includes: McKay, H; A
Sims-Gould, J; Stirling, B; Chudyk, A; Tong, C; FrankMahmood, A; Procyk, A; van Loon, J; Winters, M; DaMd; Rhodes, R; Scott, V; Paez, A; Clarke, P.
Article history:Received 25 May 2013Received in revised form 23 August 2013Accepted 21 September 2013
Although physical activity is a recognized component in the management of many chronicdiseases associated with aging, activity levels tend to progressively decline with increasing age(Manini & Pahor, 2009; Schutzer & Graves, 2004). In this article we examine the key factorsthat facilitate physical activity in highly active community-dwelling older adults. Using astrengths based approach, we examined the factors that facilitated physical activity in oursample of highly active older adults. Twenty-seven older adults participated in face-to faceinterviews. We extracted a sub-sample of 10 highly active older adults to be included in theanalyses.Based on a framework analysis of our transcriptswe identified three factors that facilitate physicalactivity in our sample, these include: 1) resourcefulness: engagement in self-help strategies suchas self-efficacy, self-control and adaptability; 2) social connections: the presence of relationships(friend, neighborhood, institutions) and social activities that support or facilitate high levels ofphysical activity; and 3) the role of the built and natural environments: features of places andspaces that support and facilitate high levels of physical activity. Findings provide insight into,and factors that facilitate older adults' physical activity. We discuss implications for programs(e.g., accessible community centers, with appropriate programming throughout the lifecourse)and policies geared towards the promotion of physical activity (e.g., the development of spacesthat facilitate both physical and social activities).
Physical activity (PA) is recognized as a key componentfor the management of many chronic diseases associatedwith aging (i.e. osteoarthritis and cardiovascular disease); forexample, “chronic resistance and aerobic exercise increasemuscle strength, aerobic capacity and bone density” (Manini &Pahor, 2009, p. 28). Given the growing proportion of older adultsthat comprise the North American population, suboptimal
levels of PA and the associated morbidity of health disordersrelated to inactivity, as well as direct and indirect economiccosts, exert a substantial strain on societies and health systems(Kohl et al., 2012).
In order to promote PA in older adults there has beenmuch research on the subject of walking and the importanceof the built environment. Research has shown that higherresidential densities, the presence ofmixed land uses, accessibletransportation, and a range of environmental facilitators such asthe provision of a wide variety of local amenities (includingpost offices, newsagents, and food stores) are associated withincreased rates of walking (Stathi et al., 2012). The quantity andalso the quality of greenspace in one's neighborhood are alsoshown to be positively relevant with regard to facilitating PAlevels (Hansmann, Hug, & Seeland, 2007; Lee & Maheswaran,2011; Maas, Van Dillen, Verheij, & Groenewegen, 2009; Maas,
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Verheij, Groenewegen, De Vries, & Spreeuwenberg, 2006;Thompson, Roe, et al., 2012).
Features of the environment such as weather, particularlyrain, wind, and cold temperatures, are some of the morefrequently mentioned barriers. Aspects of the built environ-ment such as, uneven sidewalks, slippery or uneven surfaces,hills, cars parked on sidewalks, poorly maintained gardens,cleanliness, traffic noise, and air pollution are also features thatmake neighborhoods less suitable for walking. The surfaceconditions of sidewalks are also identified as an issue for themobility of older adults. Surface materials such as stone finishesand slippery conditions related to weather are perceived asproblematic (Hanson, Ashe, McKay, & Winters, 2012). Safety,such as personal safety, environmental safety, traffic hazards andcrime, are also primary considerations for choosingwhether andwhere adultswill walk (Chaudhury,Mahmood,Michael, Campo,& Hay, 2012; Cohen-Mansfield, Marx, & Guralnik, 2003; Lockett,Willis, & Edwards, 2005; Mathews et al., 2010; Schutzer &Graves, 2004).
PA is also a key component of wellbeing and quality of lifein later life as it has been shown to contribute to a subjectiveexperience of choice, social connectivity, autonomy and/orpositive self-efficacy (McAuley et al., 2006; Metz, 2000; Ziegler& Schwanen, 2011). There is a large body of environmentalgerontology research that focuses on the importance ofthe interplay between the environment and the person infacilitating PA. Two such predominant conceptual frameworksin the environmental gerontology research include Lawton andNahemow's (1973) competence model and Rowles (1983)concept of place attachment, identity and physical and socialinsideness. Lawton and Nahemow (1973) competence modelsuggests that an individual's level of competence is matchedwith the demands of the environment; mobility can beengendered or obstructed depending on the individual's needsand what the environment offers. Rowles (1983) work under-scores an individual's connectedness to neighborhood (placeattachment). He posits that older adults personal identityis linked to their attachment and meaning of place. Thisattachment is created through social and physical insidedness.Social insideness comes from everyday social exchanges overlong periods of time resulting in an integration into thesocial fabric and an overarching identification with a locale(Yen, Shim, Martinez, & Barker, 2012). Physical insidednesscomes from familiarity and routine within specific settings.Therefore mobility is heavily influenced by an individual'ssocial exchanges and their familiarity and routine withinspecific settings.
Our understanding of the physical, sociological, psycholog-ical and environmental complexities of ageing and physicalactivity is largely derived from the discussion of older adultswho have limited mobility, older adults who are inactive andnot meeting PA guidelines and barriers to PA. These barriersinclude insufficient time, lack of facilities, transport andmoney, poor health, fatigue, lack of interest, a lack of company,enjoyment and/or knowledge, inclement weather, adverseenvironments, injury, joint pain and a perception of beingtoo old (Bird et al., 2009; Fuzhong, Fisher, & Bauman, 2005;Grossman & Stewart, 2003; Mathews et al., 2010; Moschny,Platen, Klaaßen-Mielke, Trampisch, & Hinrichs, 2011; Rasinaho,Hirvensalo, Leinonen, Lintunen, & Rantanen, 2007; Stathi et al.,2012; Wilcox, Oberrecht, Bopp, Kammermann, & McElmurray,
2005). “Over 80 per cent of older people acknowledge atleast one barrier to physical activity” (Jancey, Clarke, Howat,Maycock, & Lee, 2009, p. 197).
A limited discussion on factors found to facilitate PA inolder adults includes health, independence, family, and adesire to maintain ones appearance (Grossman & Stewart,2003; Stathi et al., 2012). There is also a body of literature onphysically active older adults, specifically master athletes, thatidentifies biological factors and abilities, as well as sustainedpractice and compensation (adaptability), that facilitate PA(Horton, Baker, & Schorer, 2008). Langley and Knight (1999)found that continued PA participation was a key adaptivestrategy for coping with changes associated with ageing.Other socio-cultural factors also found to motivate masterathletes tomaintain their PA levels include: positive self-identity,self-efficacy, empowerment, and a positive aging discourse(Dionigi, Baker, & Horton, 2011; Grant, 2001; Tulle, 2007).
To date, there is a dearth of research on community-dwellingolder adults who seem to defy PA norms and maintain a high(above average) level of PA (Jancey et al., 2009). Thus, it seemswe have the propensity within our culture (as supported by theliterature) to focus on community-dwelling older adults whohave limited mobility or who are inactive. However, we positthat the secrets of active older adults that explain how theysustain their mobility, might well be equally useful but a lessertold story (Rantakokko, Mänty, & Rantanen, 2013).
Therefore, we sought to address this question and drewupon a strengths-based perspective (Saleebey, 2006), wherethe focus is not simply to identify ‘problems’ or deficits butrather to examine individuals' capabilities.
From this ‘strengths-based vantage point’, we investigatedkey factors that facilitate PA and mobility in a sample of highlyactive community-dwelling older adults. We use Caspersen,Powell, and Christenson's (1985) definition of PA:
“Any bodily movement produced by skeletal muscles thatresults in energy expenditure. The energy expenditurecan be measured in kilocalories. Physical activity in daily lifecan be categorized into occupational, sports, conditioning,household, or other activities. Exercise is a subset of physicalactivity that is planned, structured, and repetitive and has asa final or an intermediate objective the improvement ormaintenance of physical fitness” (p. 126).
We define mobility as the “ability to move oneself (eitherindependently or by using assistive devices or transporta-tion) within environments that expand from one's home tothe neighborhood and to regions beyond” (Webber, Porter, &Menec, 2010, p. 443).
Methods and data collection
We conducted in-depth, qualitative interviews with n = 27community-dwelling older adults in Metro Vancouver, BritishColumbia. Participants were drawn from a larger cross-sectionalstudy (Walk the Talk; n = 161) that examined factors thatpromote or inhibit older adults' health and mobility, GPS andaccelerometers were also used to examine older adult's activitypatterns. For Walk the Talk, we recruited participants from aprovincial government agency that provides rental subsidiesfor low-income older adults. All of our participants meet a
Table 2Excluded vs. included participant comparisons.
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low-income threshold and spend more than 30% of theirmonthly gross household income towards the rental of ahome or apartment, rendering them eligible to receive a rentalsubsidy from the provincial government. Upon approval fromthe University of British Columbia Research Ethics Board,we mailed potential participants a letter of introduction. Amember of our research team then followed-up with a phonecall, and invited potential participants to take part in the study.Eligible participants were community-dwelling men (n = 59)and women (n = 102) residing in Metro Vancouver, BritishColumbia, over the age of 65, all of whom were in receiptof home care or Shelter Aid for Elderly Renters (SAFER)assistance, reported leaving their home at least once a weekin a typical week, were able to walk at least 10 m with orwithout a mobility aid, did not have any significant memoryproblems and who were English speaking.
Upon completion of the larger cross-sectional study, follow-up packages with information on our companion study weredistributed. One hundred and forty one of the 161 participantsconsented to future follow-up. Twenty-seven older adultswho resided across a range of neighborhoods (high, mediumand low walkability) participated in in-depth interviews. Weterminated recruitment for the qualitative study when wereached theoretical saturation (Charmaz, 2006) as determinedthrough team analysis meetings and review of field notes.
Participants were interviewed at the time and location oftheir choosing; twenty-five were interviewed in their home,and two were interviewed in local community centers. Theywere provided with a $20 grocery gift card in recognition oftheir time. Interviews lasted approximately 60–90 min, using asemi-structured interview guide. The questions in the inter-view guide were informed byWebber et al. (2010) conceptualframework of older adult's mobility. We asked participantsabout their health, physical activity, travel behaviors, and thelocal built and social environments (see Table 1 for samplequestions). Interviews were digitally recorded and transcribedverbatim by a professional transcription agency. The inter-viewer and a note-taker composed detailed field notes within24 h of the interview. As standard safety protocol for inter-viewers entering participant's private homes, our researchersalways work in teams of two. Both the interviewer and note-taker had met and worked with the participants in the earlierquantitative component of larger cross-sectional study, andparticipants knew in advance that two research teammemberswould visit their home for the interview. This present analysisemphasizes data from the verbatim interview transcripts;however, during the analysis processwe consulted the detailedfield notes for additional context. For example, if a participant
Table 1Example of relevant interview questions.
Tell us about what a typical day looks like for you?Do you currently have any medical conditions or health related complaints?Do any of these conditions limit your ability to: Get around your home?Get around your neighborhood? Go for walks? Participate in physicalactivity?
If you go for a walk in your neighborhood, why do you walk?Do you engage in physical activity more, less or the same as when youwere younger (say 20 years ago) — please explain?
Can you describe your most active day in the last week?Can you describe for me your most inactive day in the last week?Do you feel that your neighborhood is walkable? Why or why not?
Age range (years) 65–80 66–88Avg. MVPA (min/day) 14.18 min/day 47.2 min/dayAvg. # of chronic condit. 1.65 2.10
Note. Gender is calculated as a percentage.
seemed hesitant to discuss a particular topic or theme, this isdocumented in the field notes, and may help to explain whycertain parts of the transcript are less complete than others.Data were saved using ID numbers and pseudonyms to ensureanonymity, and were uploaded into the qualitative softwareanalysis program NVivo 10.
Sample
The lead author (TF), who was not involved in datacollection, independently engaged in line-by-line coding ofthe transcripts in NVivo 10, a qualitative software analysisprogram. Upon completion of coding TF identified a list ofparticipants who described higher levels of PA, includingwalking. In their transcripts, participants discussed varioushealth promoting behaviors such as health check-ups, atten-tion to their nutrition and participation in PA as a way toachieve positive health outcomes.
The accelerometer data collected from the larger cross-sectional study were used to confirm the high PA levels forthe highly active older adults and to develop the inclusioncriteria for this analysis. The inclusion criteria were based on thecurrent Canadian Physical Activity Guidelines that recommendthat older adults accumulate at least 150 min of moderate- tovigorous-intensity aerobic physical activity (MVPA) per week(Csep, 2012; Tremblay et al., 2012). Tudor-Locke et al. (2011)define 30 min of daily MVPA accumulated in addition tohabitual daily activities in healthy older adults is equivalentto taking approximately 7000–10,000 steps/day. Thereforein order for participants to be included in the companionstudy participants had to a) demonstrate high levels of PA(measured subjectively by their interviews), and b) have anMVPA thresholdN30 min/day. Based on the literature (Freedson,Melanson, & Sirard, 1998), we used intensity thresholds formoderate- (1952–5724 cpm) and vigorous-intensity activity(N5725 cpm) to represent MVPA (see Table 2 for excluded vs.included participant comparisons).
Analysis
Transcripts were reviewed using framework analysis,framework analysis is better adapted to research that hasspecific questions, a pre-designed sample and a priori issues.The prime concern is to describe and interpret what ishappening in a particular setting (Ritchie & Spencer, 2002). It
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is heavily based in, and driven by, the original accounts andobservations of the people it is about, and it allows within-caseand between-case analysis; it is comprehensive (Srivastava &Thomson, 2009). In the analysis, data is sifted, charted andsorted in accordance with key issues and themes using fivesteps: 1. familiarize; 2. identify a thematic framework; 3. index;4. chart; and 5. map and interpret (Ritchie & Spencer, 2002;Srivastava& Thomson, 2009).Wewill discuss these steps brieflybelow. Each interview was fully transcribed verbatim. Initiallytwo team members read through the transcripts to get a senseof the interviews (familiarize). Through a series of meetings apreliminary thematic framework, consisting of themes andsub-themes, was developed based on key issues and commonthemes emerging from the transcripts: built environment,personal life history, mobility, and social environment. UsingNvivo 10 software, the lead author (TF) coded interviews basedon the thematic framework, with discussion among teammembers as new sub-themes were identified. Full paragraphswere coded so that contextual meaning was not lost. As part ofthe interpretive process a series of team meetings were heldto discuss the data for common themes. For comparing andcontrasting themes within and across groups we adopted theconstant comparison method (Glaser & Strauss, 1967) whichallowed us to discover similarities and differences in the data.Our team discussed and identified cases that were relatedacross themes and cases that did not “fit” within themes.Similarities and differences between the highly active partic-ipants (n = 10) and remaining participants (n = 17) wereexamined.
During the analysis process, the team compiled a list oftranscripts that were well suited to inform developmentof vignettes. The choice of a vignette helps to illustrate theintersection of the various themes that were identifiedamong the transcripts and how they are positioned (Barter& Renold, 2000), “helping to forge connections betweenpersonal biography and social structure — the personal andthe political” (Riessman, 1993, p. 1). The team identified onehighly active older adult that was suitable to be included inthe vignette. We reread this transcript and built the vignettefollowing the review (see Fig. 1).
We used a number of strategies to reinforce the rigor ofour study including: cross-checking full transcripts againstoriginal audio files for quality and completeness; reflexivememoing throughout the data generation and data analysisprocess; identification and thoughtful examination of “out-liers” or “deviant cases” (i.e., those participants and themesthat did not fit within the overarching coding structure and theoverall “story” thatwas created by researchers and participants)(Seale & Silverman, 1997); and “member checking” throughpreparation and circulation of the summary report (Lincoln &Guba, 1985). All of the participants were sent a two page, plainlanguage summary report outlining our key findings, and wereasked to contact us if they had any questions, comments orconcerns about theway inwhichwe summarized their data. Ontheir own initiative, four participants followed-up with a phonecall or letter. For themost part, these discussions did not changethe nature of our findings, but rather, provided us with anopportunity to clarify our language, terminology or methodswith the participants. One participant's 45 minute phone calldid provide additional insights into his responses, and thesedetails were added as a second set of field notes to accompany
the transcript. Through the sharing of summary reports, wewere able to continue our engagement and dialogue with ourparticipants. This not only adds to the validity of our findings(Creswell & Miller, 2000) but also provides participants with aricher opportunity to be meaningfully engaged throughout theresearch cycle. We also created an audit trail to record all keyprocedural and analytical decisions made throughout the study(Cutcliffe & McKenna, 2004; Koch, 2006).
Findings and discussion
Based on a framework analysis of our transcripts weidentified three factors that facilitate PA in highly activeolder adults, these include: 1) resourcefulness: engagementin self-help strategies such as self-efficacy, self-control andadaptability; 2) social connections: the presence of relation-ships (friend, neighborhood, institutions) and social activi-ties that support or facilitate high levels of PA; and 3) thebuilt and natural environments: features of places andspaces that support and facilitate high levels of PA. Fig. 2illustrates the three themes and the overlap between them.For example, the social, built and natural environments areimportant to strengthen and foster resourcefulness and viceversa.
Resourcefulness
The in-depth interviews suggest that resourcefulnesswas a key facilitator to PA among the highly activeparticipants. The concept of resourcefulness has beendifferentiated from other related concepts, including coping,self-regulation, mastery, self-coherence, hardiness, andresilience (Rosenbaum, 1990; Roteg\aard, Moore, Fagermoen,& Ruland, 2010; Zauszniewski, 1996). Resourcefulness consistsof self-help strategies that are used to maintain independencein daily tasks despite adverse situations (Rosenbaum, 1990;Zauszniewski, 1996; Zauszniewski, Lai, & Tithiphontumrong,2006). Resourceful persons have better self-assessed physicalhealth (Zauszniewski, 1996),more adaptive functioning (Roteg\aard et al., 2010), a positive affect and better coping skillsleading to longer healthier lives (Jang, Poon, Kim, & Shin, 2004;Levy, Slade, Kunkel, & Kasl, 2002; Stahl & Patrick, 2011). Threedimensions of resourcefulness have been described: 1) self-efficacy; 2) self-control; and 3) adaptability (Rosenbaum, 1983,1990; Zauszniewski, 1996) (see Table 3 for definitions ofresourcefulness).
Many participants in our study discussed personal chal-lenges such as chronic illness, acute illness, personal lossessuch as death and suicide of a loved one, financial concerns/trouble and housing concerns. Themajority of participants alsolived alone 90% of the highly active participants (N = 10) and88.24% of the remaining group (N = 17) (see Table 2 forexcluded vs. included participant comparisons). However, thehighly active participants all maintained their high levels of PAdespite personal challenges. When asked about their personalchallenges in relation to PA, the highly active participantsdiscussed positive self-efficacy, self-control and adaptability.For example, they spoke about their belief in their ability tocope and to conquer challenges. They talked about beingrealistic and in control of their actions. They also talked abouttheir ability to adapt and change their course of action as
Social Environment
ResourcefulnessBuilt and Natural Envir.
High PA Levels
Fig. 2. Schematic of the three intersecting factors that facilitate PA.
Quantitative Data Collection (N = 161)MVPATravel Diaries
Qualitative Data Collection (N = 27)In-Depth Interviews
Coding Framework Development (N = 27)Team Discussions
Preliminary Thematic Framework of Key Themes and Sub-Themes
Coding Process (N = 27)Team Discussions
Identification of Key Themes and Sub-Themes Emerging
Analysis (N = 27)Team Discussions
Common ThemesIdentification of Sub-Sample
Included (N = 10)a) MVPA threshold > 30b) High subjective PA
Included (N = 10)Team Discussion
Common Themes
Excluded (N = 17)a) Inclusion criteria not met
Excluded (N = 17)Team Discussion
Common Themes
Included (N = 10) vs. Excluded (N = 17)Team Discussion
Common ThemesComparisons
Writing of Results
Fig. 1. Flow of ana sis and sample selection.
402 T. Franke et al. / Journal of Aging Studies 27 (2013) 398–409
ly
circumstances changed. One example of this is Keshan (aged66 years), who spoke at length about his adaptability and PAself-efficacy. He lives and spends a lot of time alone in aneighborhood, with an industrial feel that is very difficult towalk in. Despite this unappealing neighborhood and lack ofsocial connections, Keshan is committed to walking. Keshanwas boastful and eager to share his ability to walk greatdistances. He views the 1 mile trip to the local drug store as ashort walk:
I'll go everywhere. I already tell you I walk — to go toPharma Drug for me is nothing…Because I'm fit and I canwalk two hour (Keshan, 66 y, MVPA: 52 min/d).
Table 3Resourcefulness: key concepts and definitions.
Term Definition Example
Self-efficacy Is the belief in one's abilityto cope effectively whenfaced with adversity(Rosenbaum, 1983, 1990).
“I'm fit and I can walk twohour” (Keshan).
Self-control Involves self-monitoring ofinternal events, includingthoughts, feelings, and sen-sations to prevent interfer-ence with functioning ortask performance(Rosenbaum, 1990).
“I find that being physicallyactive keeps your mindmore alert. Keeps yourattitude up, you know, I'm amuch happier person whenI'm busy and doing things”(Robert).
Adaptability Involves taking theinitiative to employproblem-solving strategieswhen faced with stressfulsituations or conditions(Zauszniewski, 1996).Highly resourceful individ-uals have more adaptivefunctioning.
“I'll walk down the alleythrough 13th Avenuerather than on the streetbecause on the street youhave all the pollution fromthe cars” (Jack).
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A positive self-efficacy was also implied in the words ofOlga (aged 75 years), an energetic and outgoing person:
I like to brag about myself. I tell everybody I'm 75 (Olga,75 y, MVPA: 48 min/d).
Michael (aged 82 years) did not feel that he fit the stereotypeof a “senior”, to be considered as an older adult, despite the factthat he lived in senior's housing. He sawhimself as defying socialnorms for his age and discussed his high level of self-control andcommitment to PA.Henoted that he andhiswifewere known intheir neighborhood as the “Walkers”, as they walked every day,when asked why he walked, he said:
I'd say health only… walking is our main thing, to go outwalking— because we hear that slow or fast doesn't makeany difference; it's just getting out and doing it. So we dowalk at least twice a day. Sometimes we go down to theBeach and walk on the beach for, you know, a couplehours or whatever (Michael, 82 y, MVPA: 38 min/d).
Keshan also spoke to the concept of self-control as beingessential to health. He stressed the value and importance ofwhathe calls a simple life; he liveswith fewmaterial possessions, doesnot smoke, does not drink, does not eat toomuch and engages inregular PA. Keshan gets up every day and watches the morningnews and is physically active for about 45 min to an hour.He does strength training (chest presses, squats, bicep curls),balancing, stretching and deep breathing exercises.
I believe that elder people eat less, exercise more. It's goodfor health, for elder people. Eat less, exercise more (Keshan,66 years, MVPA: 52 min/day).
Adaptability is the third self-help strategy and is inter-woven with both self-control and a positive self-efficacy infacilitating PA. Using a strengths based approach, adaptabilitycame to the fore during analysis and interpretation of thedata as participants with health issues were able to adapt totheir situation for the continuation/maintenance of their PAlevels. Adaptability was explicitly articulated by one participantwith more severe health conditions. When asked what has
helped her stay active over the years, Rose (aged 73 years)responded:
Well, I think it's because I realized that if I don't, my healthis going to even deteriorate more. The major problem ismy heart right now. And I saw the cardiologist just beforeI went away because my breathing has been sort oflaboured the last 18 months, so I knew it was my heart asopposed to my lungs. So he said we have to start puttingthings in motion again. So I kind of looked at him becauseI've been through this 10 years ago, testing, testing, testingbecause they were going to do open heart surgery, theythought. But they eventually said to me, “No, you're toomuch of a risk,” so I don't do as much walking as I used to. Iused to walk a couple of miles, but I don't do it unless I'mgoing to see the specialist or I'll take the bus more sobecause I'm more laboured breathing now. I do likewalking, I mean, I've walked all my life; but if it exhaustsme too much, I just do it a little bit (Rose, 73 y, MVPA:50 min/d).
When Rosewas further prompted to respond to the question“Why do you continue being PA?” she responded:
You have to keep your old bones moving, I also havearthritis, and you know how lots of people have thatanyway. But I noticed it helps if you keep moving (Rose,73 y, MVPA: 50 min/d).
Although the highly active participants in our study arecommunity-dwelling older adults who vary in age, healthstatus, and locality they all demonstrated a variety of positiveself-efficacy, self-control and adaptability behaviors thatfacilitated their high levels of PA. Some of the highly activeparticipants demonstrated having positive self-perceptionsabout their age and were eagerly boastful about their abilityto be physically active. Interestingly, we identified that someparticipant's self-efficacy was particularly resistant to socio-cultural aging discourse, for the most part our highly activeparticipants did not see themselves as declining in age. There isconsiderable literature that suggests that PA enhances positiveaffect and that “self-efficacy is instrumental in this relation-ship” (McAuley et al., 2006, p. 101). Individuals with morepositive self-perceptions of aging tend to also practice morepreventive health behaviors (Levy&Myers, 2004). Our findingsalso demonstrate how highly resourceful older adults, such asRose, who have severe limitations and declining health, areable to exhibit self-control and adapt in order to manage theirpresent situations and remain PA, “it helps if you keepmoving”.“Those that feel old tend to be people that regard their physicallimitations as problems they have to struggle with” (Torres &Hammarström, 2006, p. 300).
Our highly active participants employed various preven-tive health behaviors that ranged from daily walks, attendingexercise classes, eating well, and getting medical advice. “Mostpeople who adopt health-promoting behaviors such as dieting,exercising, going for medical checkups and so forth – althoughthey could be doing something more pleasurable at the time –
are practicing reformative self-control” (Rosenbaum, 1989,p. 251). As Michael pointed out, the self-control strategies andadaptability skills seem to have stemmed from the highlyactive participants evidently invested interest in the value of
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preserving health, ability and independence despite declininghealth and advancing age. Our findings show that healthpromoting messages are clearly an influential component ofour cultural discourse in facilitating older adults PA, this wassimilarly found in Dionigi, Horton, and Baker's (2013) researchon Master Athletes (aged 56–90). However, our findingsalso show the importance of being resourceful (self-control,self-efficacy, adaptability) in facilitating PA and promotinghealth.
Social environment
The highly active participants spoke at length aboutthe importance of their social environments. The social environ-ment encompasses living conditions, social interactions, a senseof connectedness and belonging (World Health Organization,2013); the social environment or social conditions in whichpeople live and work have a notable influence on health. Inaddition, the social environment influences older adults' PAlevels (Hanson et al., 2012). Day (2008) found that walkingto and visiting public locations allowed older adults to feellike part of the broader community or neighborhood. Beingphysically active afforded older adults the opportunityto experience social interactions and vice versa. That is,engaging in social activities promotes PA (Salvador, Reis, &Florindo, 2010).
Robert (aged 71 years), one of our most highly activeparticipants, has severe fibromyalgia. He walks to his localcommunity center to engage in cardio and weight liftingexercises. He performs this routine 5–7 days/week, illustrat-ing a sense of self-control. He acknowledges the routine'sbenefits for his overall health. He also underscores the strongconnection between PA and socializing. Robert feels thatengaging in his weekly exercise routine at his local commu-nity center provides him with a strong social network:
On an average day, I get up at four forty-five a.m. And I getup and I get washed and dressed and I have breakfast. Andthen I leave at five thirty, and I walk up to the communitycentre. And I'm there anywhere between two and threehours, and I do cardio and weight lifting. Sometimes I goin the pool. Sometimes I just go and sit in the hot tub. Andthen I come home between — well, anywhere betweeneight thirty and ten o'clock, just depending on who I've runinto at the centre. If there are some friends or somethingthere, I'll stay longer. I've been going there for years andyears and years. And so a lot of the regular people, we knoweach other. We're friends. Some of them come here. I go tosome of their houses, you know, it depends on what we'redoing (Robert, 71 y, MVPA: 71 min/d).
In responding to the question “Why do you think you'vebeen able to keep your PA up for several decades?” Robertresponded:
Probably because I liked where I was going. When I thinkof the different — like, I was back east for a number ofyears, and I liked the set-up there and I liked the peoplethat I met there. It has to do with the location and theother people there because it is a social thing. So I wouldsay it is maybe the strongest reason probably is the social
contact… As you get into your 70's, you start to havefewer friends. And so this is another reason why I thinkit's important to get out and go to places like the communitycentre and stuff because you have the possibility of makinga new friend all the time. And you've got to, otherwiseyou're going to end up, at some point, with everybody goneand you're going to be the only one left. 'Cause I do plan tolive to at least 140 (Robert, 71 y, MVPA: 71 min/d).
James (aged 67 years) on the other hand considers himselfa “hermit”, someone who keeps to their own, as he limits hisinterpersonal interactions. While James does not socializeregularly, he enjoys the social environment of his yoga class.He has been practicing yoga for 53 years and walks daily in hisneighborhood with Nordic poles. At his yoga class, he makesthe time to connect with other members of the class:
Yeah, we get there early and talk and stuff (James, 67 y,MVPA: 49 min/d).
Jack (aged 86 years) enjoys the positive health outcomesfrom walking in his neighborhood; as well as the connectionsthat arise from the social environment.
Walking then is a good thing because it's good for yourown personal health; the thing is you also see anotheraspect of life other than the envelope that you live in. I livein a small apartment here, and it's just good to get out ofhere and see the rest of the world. Also you meet peopleand other people, you see how they live, and it's good tobe sociable and meet other people (Jack, 86 y, MVPA:31 min/d).
Our findings demonstrate the importance and value inhaving access to social activities and local facilities to sustainolder adult's PA and social connections. These findings areconsistent with Stathi et al. (2012) in that “socializing andenjoyment of spending time with friends was an indirect wayof being more active” (p. 157). There is a need to emphasizethe positive aspects of PA for older adults, “not as a means toan end (i.e. ‘correcting’ the negative aspects of aging), but toenjoy the process of participation as an end in itself” (Evans &Sleap, 2012, p. 525). The highly active participants discussedtheir involvement with the community centers (attendingweekly exercise/fitness classes) over the years and in somecases, decades. These findings aptly illustrate Rowles (1983)theory on place attachment and the importance of social andphysical insidedness in facilitating PA. Our findings emphasizethat community centers act as a hub in facilitating everydaysocial exchanges over longer periods of time, “resulting in anintegration into the social fabric” (Yen et al., 2012, p. 2) andthat the effectiveness of familiarity and routine, in terms ofactivities and programming, within specific settings facilitatescontinued PA over the lifecourse. Access to local communitycenters is key in helping to establish and maintain physicallyactive routines and build social connections “in terms of asense of attachment or connection with their community,practical benefits of security and familiarity and as beingrelated to a sense of identity through independence andautonomy” (Wiles, Leibing, Guberman, Reeve, & Allen, 2012,p. 394).
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Natural and built environments
We found that the natural and built environments facilitat-ed PA in the highly active participants. The literature showsthat exposure to the natural environment and a supportivebuilt environment (availability of sidewalks, pleasant scenery,topography, and the presence of neighborhood footpaths)strongly correlate with increased rates of walking and PA inolder adults (Brownson, Baker, Housemann, Brennan, & Bacak,2001; Frank et al., 2006; Hoehner, Brennan Ramirez, Elliott,Handy, & Brownson, 2005; Kerr, Marshall, et al., 2012; Kerr,Rosenberg, & Frank, 2012). As Robert, Jack and James madeclear above, designing communities in ways that supportbeing outdoors, walking to destinations and “providingaccess to recreational amenities can play a strong role ininfluencing physical activity for older adults” (Kerr, Rosenberg,et al, 2012, p. 46). Purposely designed, movement friendlyneighborhoods can also have long term functional healthbenefits for older adults (Jacobs et al., 2008; Kono, Kai, Sakato,& Rubenstein, 2004).
Some of the highly active participants demonstrated astrong appreciation of the natural environment in supportingtheir high PA levels. For example, Olga moved to Canada whenshewas 22 years old, and felt that having an appreciation of thenatural environment was part of being a “good Canadian”. Olgaloved to hike outdoors.When asked, “What do you enjoy abouthiking?” she responded:
Well, nature. The flowers, the trees, the birds. And to learnmore about fauna and everything (Olga, 75 y, MVPA:48 min/d).
Keshan mentioned his appreciation of the natural environ-mentwhile out on his walks around the Seawall. The Seawall isa series ofman-made, pavedwalkways and bike paths that hugthe shoreline of many sections of Metro Vancouver where wecollected our data. The Seawall connects a series of parks andgreen spaces:
You know, I can walk and walk around the wall, theSeawall and that's very beautiful (Keshan, 66 y, MVPA:52 min/d).
These findings are consistent with recent research on therole of the natural and built environments. Giles-Corti et al.(2012) note that:
Access to well-designed green space may partly influencerecreational walking by making the experience of walkingmore pleasant and enjoyable. This finding is importantgiven that questions have been raised about whether thebuilt environment is indeed a determinant of recreationalwalking (Rodriguez et al., 2006). However, there is evidencethat exposure to nature is restorative andbeneficial tomentalhealth (Francis, 2010), further supporting the importance ofgreen space (p. 28).
While the above examples illustrate the influence thenatural environment and built environment have in facilitatingPA and positive health outcomes, the following example drawsattention to the complexity of the interplay of the personal,
social, natural and built environment. Jack's PA was heavilyinfluenced by the highly walkable neighborhood he lived inand close proximity of local shops and services. However, onaccount of traffic and the associated pollution in his neighbor-hood, Jack prefers to use small alleyways, rather than mainstreets, with large sidewalks, benches, marked crosswalks,manicured trees and rows of shops and services:
Well, I like to go over to the new grocery store… becausethey've just opened up last month. They have really gooddeals down there. I can save 30 or 40 percent of my foodby going down there, but it's just a shopping trip. But I enjoyshopping. I enjoy it. And of course the new Shoppers Mart,too, down here on Queen Street, they just opened up inNovember. So I enjoy going there shopping for deals. I got tothe pointwhere it's an enjoyment forme to go shopping notjust to buy stuff, but to see if I can beat the system. It's achallenge, right? What I'll do is — say I want to go toShoppers, okay? I'll walk down to the alley this side ofGreen Street, and I'll walk down the alley through 13thAvenue rather than on the street because on the street youhave all the pollution from the cars, right? Asmuch as I can Iavoid the pollution on Green Street because it's heavy,heavy, heavy traffic there, trucks, buses, diesel, and badstuff. And it's a corridor. The buildings are only three storeyshigh so you figure the entire traffic going up and downGreen Street, it's just loadedwith pollutants in that area, so Iavoid it. I go down the alley instead. (Jack, 86 y, MVPA:31 min/d)
Although Jack lived in a highly walkable neighborhoodwith amenities close by, his “supportive” built environment didnot exclusively facilitate his PA; rather it was his adaptabilityand social needs that allowed him to remain physically active.Day (2008) found that physical environments that supportwalking also promote social interactions based on the greaterlikelihood of meeting others. As we saw earlier on, Jack'sneighborhood social environment supported his neighborhoodwalking and enhancedmeaningful social events, such as seeingpeople on the street and saying hello, Jack's neighborhood builtenvironment supported his enjoyment of “shopping not just tobuy stuff” at local shops. Jack's ability to adapt supported hisengagement with the physical environment. As the structureand proximity of families shift, life expectancy continues toexpand, and trends towards facilitating independent living areembraced, we can anticipate a future where a supportive builtenvironment and neighborhood social interactions will play anincreasingly important role in the lives of community-dwellingolder adults (Gardner, 2011). However, the important role ofpersonal adaptability, self-control and self-efficacymust not belost in our understanding and awareness of what facilitatesolder adults PA.
Accessibility to transportation was also found to beconstituent to the role of the built environment in facilitatingPA. In Metro Vancouver, public transportation consists of abus system, “SeaBus”which is a system of small ferries, and a“SkyTrain”, which functions much like a rapid light transitbut largely operates above ground.
The SkyTrain could be closer, but you can't do much aboutthat. And besides, it's good, it's 10 blocks in either direction,
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so if I weren't inclined towalk, I'd be having towalk anywaywhich is good (Ava, 74 y, MVPA: 41 min/d).
I like to walk, so I walk up to Brentwood [a Sky Trainstation and shopping district]. It's about a 12-minute walkfrom here to Brentwood. And then about 10 minutes fromBrentwood to Bonsor [Community Center]. And then I getto do that again coming back. I try to walk whenever I can(James, 67 y, MVPA: 49 min/d).
Just towalkmore, especially in the evening tomass becauseit's 25 minutes there, 25 minutes back, so it's just a perfectroutine for walking (Jack, 86 y, MVPA: 31 min/d).
Most of our highly active participants relied upon publicor active transportation to reach their local destination — theabove quotes highlight the need for accessible linkages acrossinfrastructure that supports healthy behaviors.
The following examples highlight the interplay of re-sourcefulness and the built environment when environ-ments are not highly walkable and therefore do not supportPA. Seeking solutions and developing strategies to mitigateenvironmental challenges, the highly active participantsdemonstrated the ability to adapt to their immediate environ-ments in order to maintain their PA levels. For example, Olgalives in a small mobile home park which has no sidewalks, fewtrees or plants lining the roads, and limited connectivity toother streets, green spaces or amenities. Olga deemed herimmediate environment “unwalkable”, and when asked thequestion “Where do you walk your dog?” she responded:
I take the car, you know, I don't walk here at all. I have mypoopy bag and the leash and then I go to various parks. Idrive sometimes, oh, 10 kilometres. But every day twice(Olga, 75 y, MVPA: 48 min/d).
Poor weather conditions, such as rain, were mentioned asa barrier to getting out the door and walking. However, thehighly active participants shared strategies they used toadapt their regular walking routines to maintain their PAlevels in inclement weather in order to reach their targetdestinations. When the weather was poor, both Michael andKeshan continued to go outdoors for their daily walks; theyjust chose not to walk as great a distance.
If it's not a nice day we'd probably ride up to [the grocerystore] T-Greens because we like to get out every day atleast, walk in the rain or snow or whatever (Michael, 82 y,MVPA: 38 min/d).
Rain — I don't go too long in the rain I go to library and,you know, over there have a Super Saver Foods it's inKings-mount and Betty Drive, Super Saver Foods andsome grocery, yep (Keshan, 66 y, MVPA: 52 min/d).
For many of our highly active participants, the less thandesirable built environments in which they lived did not stopthem frommaintaining high levels of PA. By adapting to their
environments or seeking out more desirable locations theywere able to go for a walk with a friend, a spouse or a pet. Ourfindings are consistent with a number of recent studies (Kerr,Rosenberg, et al., 2012; Marmot, 2011; Rantakokko et al.,2013; Sallis, King, Sirard, & Albright, 2007; Thompson, Curl,Aspinall, Alves, & Zuin, 2012) that “identified that specificelements of the community supported increased walkingactivity. These included streets with more businesses, thepresence of malls and trails, parks and green space, retaildestinations, and amenities in general” (Hanson et al., 2012,p. 4). Our findings are also consistent with Kawachi andBerkman (2003), and Rosso, Auchincloss, and Michael (2011)in that “it is unlikely that built environment characteristicsaffect all older adults in the same manner” (Rosso et al., 2011,p.7). We demonstrate the complexity of the interactionbetween the person, the social, built and natural environmentthat together facilitate older adults' PA.
Intersecting themes: Elizabeth a highly active older adult
The following vignette shows the complexity of theintersection of the various factors that facilitate PA in olderadults and how each factor (resourcefulness, social environmentand built and natural environment) is positioned in relation toone another.
Elizabeth was 72 years of age. She was a professionalgardener andnow spendsmuch of her timevolunteering at oneof the largest garden centers in Vancouver. Elizabeth faced andcontinues to facemultiple adversities; her daughter committedsuicide and her husband recently died from Parkinson's diseasethat has left her struggling financially. She is blind in one eye,has tinnitus (ringing in her ears) and arthritis in her hands, andyet Elizabeth engages in more than the Canadian PhysicalActivity Guidelines recommended MVPA per day.
Four days a week Elizabeth gets up at 5 AM and takes thebus to her local community center to take an aerobics class.While there, she works on her balance and maintaining herupper body strength. She takes the early bus in order to dosome chores at her local pharmacy or grocery store prior tothe aerobics class and to allow ample time to chat with herfriends at the community center. Depending on theweather, shewill oftenwalk home from the community center, approximate-ly a forty-five minute trip.
I have to be here — this class starts at nine-thirty but withthe way the buses run, I can either be late or early. So Ichoose to be early and do little chores beforehand, go toPharma Drugs, [grocery store] Green Grocers, whatever.And come in here still early, and chat with friends, we'veknown each other for many years, the same classes. Dothe exercise. Go to the library or whatever wasn't openbefore may be open. Sometimes I walk home. And thewalk home is about two miles. And if it's a nice day andmy feet are cooperating I walk (Elizabeth, 72 y, MVPA:48 min/d).
On other days Elizabeth gets up early and goes to the localshopping mall to do her shopping, she is out spending timewith her family who lives close by or she is volunteering atthe garden center. Elizabeth's enjoys regular walks in herneighborhood as she likes to look at how the plants and trees
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change with the seasons. Elizabeth mentions that she findsher current neighborhood calm and quiet in comparison toher previous location (downtown). However, there is a highvolume of traffic on certain routes in her neighborhood. Asthis frightens her, she adapts her walking routes as much aspossible in order to avoid traffic-laden areas. She chooses towear a special hat with a wide brim on her walks in order toprotect her eyes, as it cuts down on the glare from the sun. Shecarries with her a small backpack with a bright handkerchiefand a small flashlight in the mesh exterior pockets. Elizabethalways wears comfortable running shoes during her walks.When asked where it is that she likes to go for her walks shementions the local waterfront-walking path as her preferreddestination. She enjoys the natural environment and the abilityto shop at local grocery stores.
Just walking on the quay because it's a garden all the way,it's a mile walk one-way and a mile back. But they'reopening the new part, which will extend it to two miles.Twomiles east and twomiles west, you know, and that's afour-mile walk. And the gardens are lovely, you know, theparks board does a terrific job. I like Macy's market downthere and it's very good (Elizabeth, 72 y, MVPA: 48 min/d).
Elizabeth represents the quintessential highly active olderperson. She illustrates how resourcefulness and social, builtand natural environments are all interconnected and togetherfacilitate her high PA levels. Her personal resourcefulness andpreparedness allows her to enjoy the natural environmentwhile out on her walks. A familiar social environment at thecommunity center, coupled with the convenient location andlocal bus service, draws her out of her home on a regular basisto engage in both physical and social activities.
Conclusion
We sought to better understand how person-level charac-teristics influence older adult's PA, as this has not been welladdressed previously. We adopted a strengths based approachand our findings demonstrate that personal resourcefulness,social connections, the natural and built environments and theoverlap between these factors together influenced PA in thehighly active participants. Accessible community centers arealso key locations for social and physical activity and offerhealth-enhancing opportunities.
“To guarantee the sustainability of health and social caresystems while enhancing quality of life, it is important tofind ways to promote the functional capacity of olderpeople” (Rantakokko et al., 2013, p.19).
Our study contributes to an enhanced understanding offactors that drive the PA habits of a unique group of highlyactive older adults. We contribute to a scarce body of literaturethat describes health, independence, family, and a desire tomaintain ones appearance as facilitators for older adults PA(Grossman & Stewart, 2003; Stathi et al., 2012).
We utilized a strengths based perspective to gain insightinto themultipleways thatwell-being andmobility are context-dependent (Nordbakke & Schwanen, 2013). From this vantagepoint we begin to understand how active, older adults weave PA
into their personalmeanings of self and how this influences theiractions. Highly active older adults utilize their resourcefulness tosupport their PA and in turn, PA contributes to their definition ofself. The strengths based perspective did not obscure the criticalvoices in our study but rather established a benefits-focuseddiscourse that provided a vehicle for participants to clearlyarticulate challenges. We view this as an innovative departurefrommost PA studies of older adults that adopt a problem-basedapproach and focus more narrowly on deficits (Cowger, 1992;Hepworth, Rooney, & Larson, 2002; Saleebey, 1992, 1996,2002; Weick, 1992) as cited in Gray and Kabadaki (2005). Thefamiliar ‘deficit’ approach tends to target personal and systemlevel problems, needs and deficiencies with little focus onenhancing an individual's strengths and capabilities (McLean &McNeice, 2012).
We acknowledge limitations of our study. Although theframework analysis approach “reflects the original accountsand observations of the people studied (that is, “grounded”and inductive), it starts deductively from pre-set aims andobjectives” (Pope, Ziebland, & Mays, 2000, p. 116). Our datacollection was more structured than would be the norm formuch other qualitative research and the analytical processmore explicit andmore strongly informed by a priori reasoning,a focus on the built environment. While we provide insightinto factors that facilitate physical activity in highly activeolder persons, our study engaged older adults who were inreceipt of rental assistance (of low socio-economic status).Thus, our findings are not generalizable to older adults ofhigher socioeconomic status. This also highlights a strengthof our study, as we add to the scarce body of literaturerelated to PA in this population demographic. Older adults inlower socioeconomic strata may of necessity become moreresourceful in many ways, quite separate from their physicalactivity patterns.
A final limitation is that, accelerometers are not able tocapture all types and forms of physical activity (Welk, 2002).For example, we were not able to capture activities such asswimming, lifting weights or cycling. Further, during walking,accelerometers do not account for increased load (e.g., carrying abag of groceries) or topography (e.g., walking uphill). However,during the interviews, our participants stated that they engagedin some of these activities, and therefore they could have beenmore physically active than their accelerometry results sug-gested. Further, if an individual's primary physical activity wascycling or swimming, they may not have met the inclusioncriteria for the highly active participants group (N = 10),because their physical activity levels would have beenunder-represented by accelerometry. However, the largerstudy cross-sectional study, from which we recruited partici-pants, collected a self-reported measure of physical activity,the Community Health Activities Model Program for Seniors(CHAMPS) survey (Stewart et al., 2001). Based on the CHAMPSresults wewere able to confirm averageweekly physical activityof all 27 participants.
There is a great need for more studies that address theinfluence of the social, built and natural environments (andthe intersection between them) on older adult behaviors —
including PA. Specifically, we encourage studies that targetother older adult populations (those with higher income,of increased frailty or who are foreign born) so as to betterunderstand and serve the needs of our burgeoning aging
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population. There is also an opportunity for futurework on olderadult's PA to consider objective and the subjective dimensionsof well-being and to recognize factors that facilitate PA.
Through a better understanding of how highly activeolder adults view their PA and especially those factors thatfacilitate their will and their ability to maintain high levels ofPA has implications for program design, government healthand wellness agendas and PA intervention studies. Innovativestrategies that provide older adults the ability to form socialconnections and/or have access to aesthetically pleasing builtand natural environmentsmay be the key to sustainedmobilityand maintaining independence in later life.
Acknowledgments
This work was supported by a team grant from the CanadianInstitutes of Health Research (AAM-108607). [Name of secondauthor]'s work is supported by a Doctoral Award from theCanadian Institutes of Health Research — the Frederick Bantingand Charles Best Canada Graduate Scholarship.
References
Barter, C., & Renold, E. (2000). ‘I wanna tell you a story’: Exploring theapplication of vignettes in qualitative research with children and youngpeople. International Journal of Social Research Methodology, 3(4),307–323.
Bird, S., Kurowski, W., Feldman, S., Browning, C., Lau, R., Radermacher, H.,et al. (2009). The influence of the built environment and other factors onthe physical activity of older women from different ethnic communities.Journal of Women & Aging, 21, 33–47.
Brownson, R. C., Baker, E. A., Housemann, R. A., Brennan, L. K., & Bacak, S. J.(2001). Environmental and policy determinants of physical activity inthe United States. Journal Information, 91.
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity,exercise, and physical fitness: Definitions and distinctions for health-relatedresearch. Public Health Reports, 100, 126.
Charmaz, K. (2006). Constructing grounded theory: A practical guide throughqualitative analysis. Sage Publications Limited.
Chaudhury, H., Mahmood, A., Michael, Y. L., Campo, M., & Hay, K. (2012). Theinfluence of neighborhood residential density, physical and socialenvironments on older adults' physical activity: An exploratory studyin two metropolitan areas. Journal of Aging Studies, 26, 35–43.
Cohen-Mansfield, J., Marx, M. S., & Guralnik, J. M. (2003). Motivators andbarriers to exercise in an older community-dwelling population. Journalof Aging and Physical Activity, 11, 242–253.
Cowger, C. D. (1992). Assessment of client strengths. The strengthsperspective in social work practice, 139–147.
Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitativeinquiry. Theory into Practice, 39(3), 124–130.
Csep (2012). Canadian physical activity guidelines for older adults 65 yearsand older. Retrieved from. http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf
Cutcliffe, J. R., & McKenna, H. P. (2004). Expert qualitative researchers andthe use of audit trails. Journal of Advanced Nursing, 45, 126–133.
Day, R. (2008). Local environments and older people's health: Dimensionsfrom a comparative qualitative study in Scotland. Health & Place, 14,299–312.
Dionigi, R. A., Baker, J., & Horton, S. (2011). Older athletes' perceived benefitsof competition. The International Journal of Sport and Society, 2(2), 17.
Dionigi, R. A., Horton, S., & Baker, J. (2013). How do older masters athletesaccount for their performance preservation? A qualitative analysis.Ageing and Society, 33(02), 297–319.
Evans, A. B., & Sleap, M. (2012). “You feel like people are looking at you andlaughing”: Older adults' perceptions of aquatic physical activity. Journalof Aging Studies, 26, 515–526.
Francis, J. (2010). Associations between public space and mental health innew residental developments. Perth, WA: The University of WesternAustralia/School of Population Health.
Frank, L. D., Sallis, J. F., Conway, T. L., Chapman, J. s E., Saelens, B. E., & Bachman,W. (2006). Many pathways from land use to health: Associations between
neighborhoodwalkability and active transportation, bodymass index, andair quality. Journal of the American Planning Association, 72, 75–87.
Freedson, P. S., Melanson, E., & Sirard, J. (1998). Calibration of the ComputerScience and Applications, Inc. accelerometer. Medicine and Science inSports and Exercise, 30, 777.
Fuzhong, L., Fisher, K., & Bauman, A. (2005). Neighbourhood influences onphysical activity. Journal of Aging and Physical Activity, 13, 87–114.
Gardner, P. J. (2011). Natural neighborhood networks — Important socialnetworks in the lives of older adults aging in place. Journal of AgingStudies, 25, 263–271.
Giles-Corti, B., Bull, F., Knuiman, M., McCormack, G., Van Niel, K., Timperio,A., et al. (2012). The influence of urban design on neighbourhoodwalking following residential relocation: Longitudinal results from theRESIDE study. Social Science & Medicine, 77, 20–30.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory:Strategies for qualitative research. Aldine de Gruyter.
Grant, B. C. (2001). ‘You're never too old’: Beliefs about physical activity andplaying sport in later life. Ageing and Society, 21(06), 777–798.
Gray, J. I., & Kabadaki, K. (2005). A strengths perspective for assessing olderadults: Curriculum enrichment in a human behavior course. Journal ofBaccalaureate Social Work, 55–66.
Grossman, M. D., & Stewart, A. L. (2003). “You aren't going to get better byjust sitting around”: Physical activity perceptions, motivations, andbarriers in adults 75 years of age or older. The American Journal of GeriatricCardiology, 12, 33–37.
Hansmann, R., Hug, S. M., & Seeland, K. (2007). Restoration and stress reliefthrough physical activities in forests and parks. Urban Forestry & UrbanGreening, 6(4), 213–225.
Hanson, H. M., Ashe, M. C., McKay, H. A., & Winters, M. (2012). Intersectionbetween the built and social environments and older adults' mobility: Anevidence review.
Hepworth, D., Rooney, R., & Larsen, J. (2002). Direct social work practice:Theory and skills (5th ed.)Belmont, CA: Brooks/Cole.
Hoehner, C. M., Brennan Ramirez, L. K., Elliott, M. B., Handy, S. L., & Brownson,R. C. (2005). Perceived and objective environmentalmeasures andphysicalactivity among urban adults. Americal Journal of Preventive Medicine, 28,105–116. http://dx.doi.org/10.1016/j.amepre.2004.10.023.
Horton, S., Baker, J., & Schorer, J. (2008). Expertise and aging: maintainingskills through the lifespan. European Review of Aging and PhysicalActivity, 5(2), 89–96.
Jacobs, J. M., Cohen, A., Hammerman-Rozenberg, R., Azoulay, D., Maaravi, Y.,& Stessman, J. (2008). Going outdoors daily predicts long-term functionaland health benefits among ambulatory older people. Journal of Aging andHealth, 20, 259–272.
Jancey, J. M., Clarke, A., Howat, P., Maycock, B., & Lee, A. H. (2009). Perceptionsof physical activity by older adults: A qualitative study. Health EducationJournal, 68, 196–206.
Jang, Y., Poon, L. W., Kim, S. Y., & Shin, B. K. (2004). Self-perception of agingand health among older adults in Korea. Journal of Aging Studies, 18,485–496.
Kawachi, I., & Berkman, L. F. (2003). Neighborhoods and health. New York:Oxford University Press.
Kerr, J., Marshall, S., Godbole, S., Neukam, S., Crist, K., Wasilenko, K., et al.(2012). The relationship between outdoor activity and health in olderadults using GPS. International Journal of Environmental Research andPublic Health, 9, 4615–4625.
Kerr, J., Rosenberg, D., & Frank, L. (2012). The role of the built environment inhealthy aging community design, physical activity, and health amongolder adults. Journal of Planning Literature, 27, 43–60.
Koch, T. (2006). Establishing rigour in qualitative research: The decisiontrail. Journal of Advanced Nursing, 53, 91–100.
Kohl, H. W., Craig, C. L., Lambert, E. V., Inoue, S., Alkandari, J. R., Leetongin, G.,et al. (2012). The pandemic of physical inactivity: Global action forpublic health. The Lancet, 380, 294–305.
Kono, A., Kai, I., Sakato, C., & Rubenstein, L. Z. (2004). Frequency of goingoutdoors: A predictor of functional and psychosocial change amongambulatory frail elders living at home. The Journals of Gerontology SeriesA: Biological Sciences and Medical Sciences, 59, M275–M280.
Langley, D. J., & Knight, S. M. (1999). Continuity in sport participation as anadaptive strategy in the aging process: A lifespan narrative. Journal ofAging and Physical Activity, 7(1), 32–54.
Lawton, M. P., & Nahemow, L. (1973). Ecology and the aging process.Lee, A. C. K., & Maheswaran, R. (2011). The health benefits of urban green
spaces: A review of the evidence. Journal of Public Health, 33(2), 212–222.Levy, B. R., & Myers, L. M. (2004). Preventive health behaviors influenced by
self-perceptions of aging. Preventive Medicine, 39, 625–629.Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased
by positive self-perceptions of aging. Journal of Personality and SocialPsychology, 83, 261–270. http://dx.doi.org/10.1037//0022-3514.83.2.261.
409T. Franke et al. / Journal of Aging Studies 27 (2013) 398–409
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: SagePublications.
Lockett, D., Willis, A., & Edwards, N. (2005). Through seniors' eyes: Anexploratory qualitative study to identify environmental barriers to andfacilitators of walking. Canadian Journal of Nursing Research, 37, 48–65.
Maas, J., Van Dillen, S. M. E., Verheij, R. A., & Groenewegen, P. P. (2009).Social contacts as a possible mechanism behind the relation betweengreen space and health. Health & Place, 15(2), 586–595.
Maas, J., Verheij, R. A., Groenewegen, P. P., De Vries, S., & Spreeuwenberg, P.(2006). Green space, urbanity, and health: How strong is the relation?Journal of Epidemiology and Community Health, 60(7), 587–592.
Manini, T. M., & Pahor, M. (2009). Physical activity and maintaining physicalfunction in older adults. British Journal of Sports Medicine, 43, 28–31.
Marmot, M. (2011). Fair society, healthy lives: Strategic review of healthinequalities in England post 2010. (2013).
Mathews, A. E., Laditka, S. B., Laditka, J. N., Wilcox, S., Corwin, S. J., Liu, R.,et al. (2010). Older adults' perceived physical activity enablers andbarriers: A multicultural perspective. Journal of Aging and PhysicalActivity, 18.
McAuley, E., Konopack, J. F., Motl, R. W., Morris, K. S., Doerksen, S. E., &Rosengren, K. R. (2006). Physical activity and quality of life in olderadults: Influence of health status and self-efficacy. Annals of BehavioralMedicine, 31(1), 99–103.
McLean, J., & McNeice, V. (2012). Assets in action: Illustrating asset basedapproaches for health improvement. Glasgow: Glasgow Centre for Popula-tion Health.
Metz, D. H. (2000). Mobility of older people and their quality of life. TransportPolicy, 7(2), 149–152.
Moschny, A., Platen, P., Klaaßen-Mielke, R., Trampisch, U., & Hinrichs, T.(2011). Barriers to physical activity in older adults in Germany: Across-sectional study. International Journal of Behavioural Nutrition andPhysical Activity, 8, 121.
Nordbakke, S., & Schwanen, T. (2013). Well-being and mobility: A theoreticalframework and literature review focusing on older people.Mobilities, 1–26.
Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care:Analysing qualitative data. BMJ: British Medical Journal, 320(7227), 114.
Rantakokko, M., Mänty, M., & Rantanen, T. (2013). Mobility decline in oldage. Exercise and Sport Sciences Reviews, 41, 19–25.
Rasinaho, M., Hirvensalo, M., Leinonen, R., Lintunen, T., & Rantanen, T.(2007). Motives for and barriers to physical activity among older adultswith mobility limitations. Journal of Aging and Physical Activity, 15.
Riessman, C. K. (1993). Narrative analysis, Vol. 30, Sage.Ritchie, J., & Spencer, L. (2002). Qualitative data analysis for applied policy
research. The Qualitative Researcher's Companion, 305–329.Rodriguez, D., Khattak, A., & Evenson, K. (2006). Can new urbanism
encourage physical activity? Journal of American Planning Association,72, 43–54.
Rosenbaum, M. (1983). Learned resourcefulness as a behavioral repertoirefor the self-regulation of internal events: Issues and speculations.Perspectives on Behavior Therapy in the Eighties, 9, 54–73.
Rosenbaum, M. (1989). Self-control under stress: The role of learnedresourcefulness. Advances in Behaviour Research and Therapy, 11, 249–258.
Rosenbaum, M. (1990). Learned resourcefulness: On coping skills, self-control,and adaptive behavior. Springer Publishing Co.
Rosso, A. L., Auchincloss, A. H., & Michael, Y. L. (2011). The urban builtenvironment andmobility in older adults: A comprehensive review. Journalof Aging Research, 2011.
Roteg\aard, A. K., Moore, S. M., Fagermoen, M. S., & Ruland, C. M. (2010).Health assets: A concept analysis. International Journal of Nursing Studies,47, 513–525.
Rowles, G. D. (1983). Place and personal identity in old age: Observationsfrom Appalachia. Journal of Environmental Psychology, 3(4), 299–313.
Saleebey, D. (1992). The strengths perspective in social work practice. NewYork: Longman.
Saleebey, D. (1996). The strengths perspective in social work practice:Extensions and cautions. Social Work, 41, 296–305.
Saleebey, D. (Ed.). (2002). The strengths perspective in social work practice(3rd ed.). Boston: Allyn & Bacon.
Saleebey, D. (2006). Strengths perspective in social work practice, 4/e. The.24 cm. 336p. 5Rev e. pbk, 31.
Sallis, J. F., King, A. C., Sirard, J. R., & Albright, C. L. (2007). Perceived environmentalpredictors of physical activity over 6 months in adults: Activity CounselingTrial. Health Psychology, 26, 701.
Salvador, E. P., Reis, R. S., & Florindo, A. A. (2010). Practice of walking and itsassociation with perceived environment among elderly Brazilians livingin a region of low socioeconomic level. International Journal of BehavioralNutrition and Physical Activity, 7, 67.
Schutzer, K. A., & Graves, B. S. (2004). Barriers and motivations to exercise inolder adults. Preventive Medicine, 39, 1056–1061.
Seale, C., & Silverman, D. (1997). Ensuring rigour in qualitative research. TheEuropean Journal of Public Health, 7, 379–384.
Srivastava, A., & Thomson, S. B. (2009). Framework analysis: A qualitativemethodology for applied policy research. JOAAG, 4(2), 72–79.
Stahl, S. T., & Patrick, J. H. (2011). Perceived functional limitation and healthpromotion during mid-to late life: The mediating role of affect. The NewSchool Psychology Bulletin, 8.
Stathi, A., Gilbert, H., Fox, K. R., Coulson, J., Davis, M., & Thompson, J. L.(2012). Determinants of neighborhood activity of adults age 70 andover: A mixed-methods study. Journal of Aging and Physical Activity, 20,148–170.
Stewart, A. L., Mills, K. M., King, A. C., Haskell, W. L., Gillis, D., & Ritter, P. L.(2001). CHAMPS physical activity questionnaire for older adults:Outcomes for interventions. Medicine and Science in Sports and Exercise,33(7), 1126–1141.
Thompson, C. W., Curl, A., Aspinall, P., Alves, S., & Zuin, A. (2012). Do changesto the local street environment alter behaviour and quality of life of olderadults? The ‘DIY Streets’ intervention. British Journal of Sports Medicine, 10,1250–1267.
Thompson, C. W., Roe, J., Aspinall, P., Mitchell, R., Clow, A., & Miller, D.(2012). More green space is linked to less stress in deprived communities:Evidence from salivary cortisol patterns. Landscape and Urban Planning,105(3), 221–229.
Torres, S., & Hammarström, G. (2006). Speaking of ‘limitations’ while trying todisregard them: A qualitative study of how diminished everyday compe-tence and aging can be regarded. Journal of Aging Studies, 20(4), 291–302.
Tremblay, M. S., LeBlanc, A. G., Carson, V., Choquette, L., Connor Gorber, S.,Dillman, C., et al. (2012). Canadian physical activity guidelines for the earlyyears (aged 0–4 years). Applied Physiology, Nutrition, and Metabolism, 37,345–356.
Tudor-Locke, C., Craig, C. L., Aoyagi, Y., Bell, R. C., Croteau, K. A., De Bourdeaudhuij,I., et al. (2011). Howmany steps/day are enough? For older adults and specialpopulations. International Journal of Behavioural Nutrition and PhysicalActivity, 8, 80. http://dx.doi.org/10.1186/1479-5868-8-80.
Tulle, E. (2007). Running to run: Embodiment, structure and agency amongstveteran elite runners. Sociology, 41(2), 329–346.
Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults:A comprehensive framework. The Gerontologist, 50, 443–450.
Weick, A. (1992). Building a strengths perspective for social work. In D.Saleebey (Ed.), The strengths perspective in social work practice. NewYork: Longman.
Welk, G. J. (2002). Use of accelerometry-based activitymonitors to assess physicalactivity. Physical Activity Assessments for Health-Related Research, 125–141.
Wilcox, S., Oberrecht, L., Bopp, M., Kammermann, S. K., & McElmurray, C. T.(2005). A qualitative study of exercise in older African American andwhitewomen in rural South Carolina: Perceptions, barriers, and motivations.Journal of Women & Aging, 17, 37–53.
Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., & Allen, R. Es. (2012). Themeaning of “aging in place” to older people. The Gerontologist, 52, 357–366.
World Health Organization (2013). Social environment.Yen, I. H., Shim, J. K., Martinez, A. D., & Barker, J. C. (2012). Older people and
social connectedness: How place and activities keep people engaged.Journal of Aging Research, 2012, 1–10.
Zauszniewski, J. A. (1996). Self-help and help-seeking behavior patterns inhealthy elders. Journal of Holistic Nursing, 14, 223–236.
Zauszniewski, J. A., Lai, C., & Tithiphontumrong, S. (2006). Development andtesting of the Resourcefulness Scale for Older Adults. Journal of NursingMeasurement, 14, 57–68.
Ziegler, F., & Schwanen, T. (2011). ‘I like to go out to be energised bydifferent people’: An exploratory analysis of mobility and wellbeing inlater life. Ageing and Society, 31(5), 758.
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