Intrapersonal
The individual older adult is at the centre of the PL model. Intrapersonal elements include personal factors reflecting the four elements of the definition of PL, each of which may increase or decrease the likelihood of an older adult becoming or remaining physically active. Strategies that bring change at the individual level focus on an individual’s motivation and confidence, physical competence, knowledge and understanding, and assist in engagement in PA participation as an integral part of one’s lifestyle.
Motivation to be physically active in the older adult population can vary from younger populations; primarily influenced by health concerns and anticipated benefits [
26‐
28]. For example, as people age, motives that indicate pragmatic or instrumental concerns, seem to override ones that might be more personally uplifting. This has previously been reported by Trujillo et al. [
29] who demonstrated that, as opposed to younger adults who exhibit greater concern for interpersonal attraction outcomes, older adults exhibit greater concern for health outcomes. As such, health and maintaining physical and mental independence may be potent motivators for PA participation in older adults. Although there may be general age-related changes in participatory motives, evidence suggests that motivation to engage in various types of physical activities is multifaceted and draws on a wide range of reasons beyond health and fitness benefits, in both exercise and sport domains. For example, characterises of adaptive motivation may relate to determination (fulfilling needs for autonomy, competency, and relatedness) and whether the motives are personally meaningful and integrated to important values and beliefs held by middle-aged and older adults [
30‐
33].
Adherence to structured exercise programs is consistently associated with higher exercise-related self-efficacy, that is,
confidence in both performing specific exercises and in planning to exercise [
11,
34]. Further, confidence to make and sustain feasible changes and confidence to overcome barriers, are key factors in the likelihood of making lifestyle change among older adults [
10]. In addition, as in younger populations, confidence related to current PA participation is shaped by past experiences [
35,
36]. Therefore, it is important to gain insight into an older adult’s past PA history; including understanding which PA skills they learned and the context in which they were learned, which skills they may be re-learning, or skills confronted for the first time. Finally, previous adverse events and perceived risks associated with PA participation may also impact confidence. As such, fear of falling or fear of exacerbating health conditions during physical activities are barriers that can be mitigated, for example, through improving balance confidence [
37].
The physical competence element of PL refers to an individual’s ability to develop and/or re-learn important functional movement skills and patterns, and the capacity to experience these skills through a variety of movement intensities and durations. Current PA models describe a pathway from birth to adulthood and therefore may not apply to older adults who may not have developed any or certain skills (base functional movement skills) or who have not engaged in activities using these skills for many years. Further, the current models reflect a time of growth and development during skills acquisition and again, may not be applicable to the older adult living with age-related physiological changes, who may be more focused on retention rather than regaining past skills or learning new ones. Therefore, an important question toward increasing the physical competence element of PL in older adults includes what changes to the nervous system, motor systems, and motor skill learning will influence ability to engage in acquired movement skills and/or to learn new movements, in light of primary age-related changes of physiological systems?
Age-related declines in physical fitness and performance are such that physical limitations may impinge on functional activities of daily living [
2], resulting in higher rates of disability [
38], and are associated with all-cause mortality and premature death [
39]. It is not surprising that mobility troubles, fear of falling, and health conditions are reported barriers to PA participation among Canadian older adults [
40]. Given the episodic nature of many chronic conditions, there may be more treatable moments or thresholds at which time perceived barriers are more, or less, debilitating than at other times. Appropriate exercise training can minimize declines and maximize physical competence, thus mitigating the rates at which older adults cross thresholds of functional inability. In addition, increased participation and competence in PA can reduce negative attitudes towards the aging process [
12‐
14]. This is analogous to applications of the concept of resilience to coping with illness among older adults, broadly defined as a dynamic adaptive process through which individual traits, characteristics of their environment, and their internal and external resources, and physical capacity, are utilized in the face of adversity [
41]. Older adults are capable of resilience to adverse health events despite socioeconomic backgrounds, personal experiences, and declining health. Research suggests that strong mental, social, and physical characteristics are associated with better resilience among older adults [
42]. Physical activity and social engagement often associated with functional resilience are considered fundamental in coping with chronic disease and multimorbidity, which are common in older age groups [
43].
An older adult’s awareness and comprehension of the PA guidelines, understanding of the role of PA in healthy aging, knowing about movement skill parameters, methods of improvement, and safe participation modifications are all
knowledge and understanding elements of PL. Similar to younger populations, older adults tend to have limited knowledge of current PA recommendations for their age-group [
44] and on accruing appropriate intensities for meaningful health benefits [
45]. Physical activity interventions that include an educational component addressing these elements can increase outcome expectations, skills knowledge, and knowledge on effective doses and types of PA [
46]. In addition, older adults should have knowledge and understanding of what barriers to PA and sport participation exist. Not enough time, lack of motivation, ageism and feelings of being too old, perceiving few sport facilities and/or physical activity opportunities nearby, and lack of support from others, are all recognized as consistent barriers for older adults. The literature on perceived barriers to participate in PA and sport suggests that these challenges are consistently reported among older adults [
34,
47]. These barriers are all influenced by how older adults view themselves and how they are cognizant of, and understand the ecology and opportunities surrounding them.
There is vast room for improvement in encouraging older adults to make the choice to be physically active. Along with previously identified motivators and barriers,
prioritizing and sustaining engagement in physical activities as an integral part of one’s lifestyle can be influenced by outcomes expectations, perceptions of older age and attitudes towards aging and exercise. The belief that a PA behaviour, in this case PA, will bring about a certain consequence (outcomes expectations) and identifying which sub-category (physical, social and/or self-evaluative) is personally meaningful may further increase engagement [
48]. Negative stereotyping of old age (including cultural, societal stereotypes) and low expectations for old age, may interfere with the possibility for improvement via healthy lifestyle behaviors [
28]. For example, a sample of inactive older persons perceived themselves to be physically active, because their perception of PA was grounded in a social context [
27]. Both of these perceptions may interfere with the recognition and value of regular PA as a personally meaningful and integral part of life. Conversely, highly active older adults utilize their resourcefulness to support their PA and in turn, PA contributes to their definition of self [
48]. Similarly, literature on adult sport [
49] [
30,
50], indicates that negative attitudes and feeling too old to engage in sport are common barriers constraining activity. This behavioural PL element suggests a role in assisting older adults to link the value of, or belief in PA and behaviour change to regular PA participation.
Finally, at the intrapersonal level, there are individual factors identified to be unique to the PA levels of older adults. For example, differences between males and females or variations across the older adult age-range. Other groups at risk for low PA levels include, women, older adults with low incomes and/or low education levels, older adults living with disabilities and/or chronic health conditions, those who live in institutions or in isolation, and seniors who are members of ethno-cultural and ethnolinguistic minority population groups [
51]. Each individual has a cultural identity and understanding cultural context can act as starting point to assist older adults. In addition, there must also be consideration for examination of PL from a life course perspective. Such a broad perspective is important for all of these identified factors, which requires a flexible and tailored approach to PL. Although children and youth are likely to have some continuity to participation in sport and PA, older adults are more likely to cycle in and out of the model as they advance across the lifespan. This ebb and flow pattern of PA is likely to be partially driven by intrapersonal engagement, and how many of the identified individual factors interact with social opportunities, seen at the interpersonal, organizational and community levels of the model.
Interpersonal
Interpersonal elements that influence PL in older adults are described by a spectrum of formal and informal personal relationships, often broadly termed social support.
Personal relationships such as family, friends, and broader personal social networks such as work/volunteer peers, caregivers, health providers may influence PA participation among older adults [
52]. While extensive research on each of these is limited, they represent potential sources (positive and negative) of interpersonal messages and varying types of support influencing older adult’s understanding of PL. A shrinking social circle (especially if they lose an exercise buddy) may negatively influence PA participation with age [
53], as may low social support from a ‘significant other’ [
54], or from friends [
55]. In older adult clinical populations, family support for PA may be lacking out of fear of harm [
56]. Conversely, positive personal social support from family, friends, and neighbours can be enablers for PA [
57‐
59] as can be co-participants and PA leaders [
60]. Social support through faith-based network positively supports PA participation [
61,
62]. Primary care physicians are often identified as having an effective role in counselling older adults on PA. Ultimately, such actions would engender PL in the patient, particularly if it is addressed within the context of a health problem [
58,
63,
64]. Understanding the influence personal relationships can have on fostering PL in older adults is of importance, specifically to facilitate individual behavior change. By affecting social and cultural norms and overcoming individual-level barriers to organized programs and services, that support participation in lifelong PA we will be able to facilitate a deeper understanding of PL by the older adult.
Organizational
Organizational elements that influence PL in older adults are described by programs, resources, and services that offer personally meaningful, culturally relevant, and accessible opportunities for PA participation.
With respect to program factors, in September 2007, the National Coalition on Aging, the National Blueprint Office, and Active for Life in the U.S. convened a meeting entitled “Building on Best Practices: Physical Activity Programming in the Aging Network”. This meeting addressed issues related to widely disseminating information on best practices and evidence-based programs to community organizations that serve older adults. The meeting highlighted the importance of selecting evidence-based PA programs to optimize health outcomes, promoting current guidelines, the importance of developing user-friendly resources to increase program access and support, and the importance of quality program evaluation of these initiatives. In addition, Stewart et al., [
65] highlighted the need for community physical-activity-promotion programs to be integrated into settings that have the infrastructure, culturally competent staff, access to exercise specialists, and experience in providing outreach and delivering the program to diverse populations. Culturally appropriate interventions have shown mixed results as to their advantage compared to standard interventions; however, most studies are limited due to small target populations, short follow-up, and methodological problems [
66].Yet, they signal the importance of expanding frameworks for practice to be consistent with the reality of diverse community contexts and individuals engaging in pluralistic options and hybrid approaches of PA [
67].
An important aspect of user-friendly and accessible programming that can influence PL relates to the quality of leaders and coaches associated with PA programs [
68]. Curriculum guidelines outlining educational standards for exercise leadership of older adults are available [
69]. Nevertheless, in the exercise domain, the quality and relatability of a group leader can be recognized as a factor to motivate and increase older adults’ adherence to PA [
60]. Peer-led activities, where older adults are matched with peers also demonstrate increased retention to PA programs [
70,
71]. Older adults who participated in a fitness program with peer mentors had improved well-being, improved social functioning, enhanced ability to carry out physical and emotional roles, and increased vitality [
72]. In seniors sport, emerging work underscores the importance of coaches who can relate to, and understand, the nuances of interacting with mature older adults [
32,
73]. For example, effective leaders often take instructional steps or collaborative conversations to satisfy older adults’ need to know the rationale for why they are practicing something before they undertake it and afford opportunities to self-direct when it is reasonable or safe to do so. Effective adult sport coaches engage in more collaborative conversations and learner-centered questioning during learning activities than they do with younger participants. Not all coaches use such measures, nor do all older adults prefer such approaches (based on given situations and the goals for learning) [
74]. However, this work suggests that quality PA experiences depend to an extent on tailoring instructional leadership and programs to older adults’ preferences. Such considerations would plausibly come to bear on intrapersonal factors related to motivation, competency, knowledge, understanding and responsibilities toward PA.
While public health promotion focuses largely on group fitness programming for older adults, there is evidence to support the observation that many older adults prefer to exercise independently (or with some instruction either directly or through media-based programs) rather than in a group setting or class-based setting [
11,
75,
76]. Therefore, there is a need to promote a wide range of options [
77]. Evidence from trials comparing multiple long-term interventions suggests that mode of delivery is not necessarily important for effectiveness but that tailoring the intervention to participants may be important [
78]. It has also been identified that interventions and promotion needs to occur at multiple levels in a variety of settings, and utilizing different technologies and modalities, that fully take into account determinants of PA [
75]. Perceived lack of accessibility to nearby facilities due to transportation barriers or functionally appropriate opportunities is also a valid consideration [
30,
45,
47,
50]. In addition, there is need for qualified exercise specialists who will be able to administer effective programming to an older adult population with varied needs and abilities [
69].
Overall, these strategies are intended to facilitate individual behavior change by influencing organizational systems, leveraging resources and participation of community institutions, and advocacy groups, which represent potential sources of support and communication. Strategies for optimizing programs and building capacity in various organizations facilitate interactive support more broadly at the community level.
Policy
The multidimensional PL model presented in this paper is the product of the expertise and knowledge of a large multidisciplinary team of researchers and stakeholders engaged in PA knowledge translation aimed at increasing PA levels. At the outer-edge of our ecological model resides the
policy component which is integral to all other components within the model. Policy is what will shape and support elements within the model that facilitate lifelong PA adoption. This model developed specifically for older adults is a recommended policy element for active and healthy aging initiatives across pan-governmental and multi-sectoral levels, and non-governmental organizations. The testing, refinement, and application of a PL model targeting older adults has the potential to be instrumental in improving quality of life, and ultimately the health status, of a rapidly growing older population. To ensure benefits are derived from these approaches, more tools and more effective tools are needed to evaluate, translate, and disseminate research and its findings [
97].
Indeed, prevention and maintenance of chronic illness, and enriched quality of life, through the enhancement of PA among older adults has an enormous potential to reduce the burden on the health care system as we move into a period of rapid population aging [
97].
The PL model for older adults can be integrated with other major policy developments, such as the age-friendly community movement, national strategies to reduce social isolation [
98] and foster community engagement among seniors, ParticipACTION, and prevention components from the National Alzheimer’s Strategy [
99], as well as those connected to a National Seniors Strategy [
100]. Overall, policy makers must consider all occasions that expose older adults to different movement opportunities and experiences. However, policy makers must also recognise the heterogeneity for both physical and cognitive function observed across the older adult population and as such guide PL programing to be effective at both the marco and micro levels [
101].