The positive relationship between health and physical activity is well recognised globally (Fernhall et al., 2015, pp. 299, 304; Ozemek et al., 2019, p. 102; Pratt et al., 2015, p. 356; World Health Organisation, 2015), especially in the context of disease mitigation and management (Prohaska et al., 2006, pp. S268-S269; Taylor et al., 2004), and reducing the risk of morbidity and mortality (Katzmarzyk & Mason, 2009, p. 271; Ozemek et al., 2019, p. 106).

There is also strong evidence linking physical activity and quality of life and wellbeing in older adults (Marquez et al., 2020), for example mental health (Guthold et al., 2018). These benefits are particularly relevant for older women who characteristically live longer and are at higher risk for some chronic conditions (Guthold et al., 2008; Public Health Agency Canada, 2020).

Paradoxically, there is an age-related decline in physical activity in older people (Doyon et al., 2021; Hallal et al., 2012), especially women (Ozemek et al., 2019, p. 103). In an effort to counter this trend, and build on the successful ParticipACTION (ParticipACTION Report Card Development Team, 2021), Choose to Move (Franke et al., 2021), and Get Fit for Active Living (Stathokostas et al., 2017) campaigns, among others, Canada recently issued new movement guidelines for older people (Canadian Society for Exercise Physiology CSEP, 2020). Compared to the guidelines released by the World Health Organisation (Bull et al., 2020) and the United States of America (USA) (Piercy et al., 2018), for instance, Canada’s guidance integrates physical activity, sedentary behaviour, and sleep patterns to formulate at a 24 h activity plan: “Replacing sedentary behaviour with additional physical activity and trading light physical activity for more moderate to vigorous physical activity, while preserving sufficient sleep, can provide greater health benefits.” (CSEP, 2020).

These initiatives are complemented by research into the discipline of physical activity in general (Rhodes & Nasuti, 2011), and physical activity and ageing specifically (King & King, 2010; Muller et al., 2016). Many of these studies relate older people’s activity to the physical and/or built environment and community neighbourhoods in an urban setting (Wasfi et al., 2016). As such, they underscore the importance of parks (Evenson et al., 2016; Kaczynski et al., 2007, 2009), in terms of older users’ preferences for aesthetics, walkabilty (Cerin et al., 2022) and open green spaces (Moran et al., 2014).

However, the evidence linking the natural environment, greenness, and active living (Calogiuri & Chroni, 2014; Christie et al., 2021; McMorris et al., 2015), has not yet evolved into an upsurge in research centred on physical activity in rural areas (Chrisman et al., 2014, p. 353; Frost et al., 2010). For instance, Nykiforuk et al., (2018) found only four directly relevant articles in their comprehensive evidence review into the promotion of physical activity in Canadian rural, remote, and northern settings.

This rural “neglect” (Canadian Rural Revitalization Foundation, 2015, p. ii) has translated into a Canadian “Call for Action” (Nykiforuk et al., 2018):

Access to supportive settings for physical activity is an important means to promote health and well-being by making it easier for individuals to incorporate physical activity into their day. The lack of policy, practice, and research action on physical activity and features of the physical, built, and natural environments in rural, remote, and northern settings is a significant threat to population health equity in Canada. (p. 11)

Although this directive refers to physical activity in all ages, the situation is perhaps more concerning when contextualised to older adults. Many rural and remote areas in Canada are characterised by rapidly ageing populations, comprised of higher proportions of older women (Leclerc, 2021, pp. 12–13). To date, there is a paucity of research into physical activity among older people in rural Canada (Chrisman et al., 2014, p. 353; Schmidt et al., 2016); even fewer studies are centred on older women.

Accordingly, this scoping review aims to redress this deficit by focusing on physical activity among older women living in rural Canada.

Literature Review

The literature review is oriented to Canada where possible, with wider evidence referenced for additional breadth and depth as needed. Much of the research into physical activity, older women, and rurality is marked by divergent contexts and characteristics: often in tandem with the assumption of homogeneity (Dollman et al., 2016, p. 2).

Physical activity

Some studies categorise physical activity as a generic entity, such as leisure-time physical activity, without regard to the diversity represented by this genre. This disconnect is exemplified in Sun et al.’s (2013) review of physical activity in older people: their study was impeded by differences in definitions, domains, instrumentation, and cut-off points. Many of these designations overlap, and cover a broad spectrum of physical activity, ranging from types (leisure, occupational, transport, and home-based activity, Pratt et al., 2004); daily physical behaviours including steps (Mitchell et al., 2018), light, moderate to vigorous activity, active transport (Klicnik & Dogra, 2019); sport (Gayman et al., 2017); exercise (formal, structured, planned, and repetitive activities, Koeneman et al., 2011); physical fitness (Doyon et al., 2021), mobility (Hanson et al., 2012; Hirsch et al., 2017; Ottoni et al., 2016; Yen et al., 2014), to recreation (Canadian Parks and Recreation Association/Interprovincial Sport and Recreation Council, 2015). For many authors, physical activity is associated with unstructured daily lifestyle activity, often synonymous with walking.

Measurement of physical activity is equally variable, and encompasses objective instruments (accelerometers, pedometers), self-report, and/or indicators of intensity, frequency, and duration (Colley et al., 2018); physiological measures such as the Compendium of Physical Activities standardising Metabolic Equivalents of Tasks (METS) (Guthold et al., 2008; Ng & Popkin, 2012, pp. 661–662); and equivalency conversions (kilocalories used per kilogram of body weight per day into active, moderately active, and inactive categories) (Gilmour, 2007, p. 45). In Canada, national-level standards are embedded in The Canadian National Movement Guidelines (Ross et al., 2020) and Active Canada 2020: A Physical Activity Plan for Canada (Spence et al., 2020).

From a public health perspective, physical activity is often treated as a health behaviour (Rhodes et al., 2017); an adjunct to nutrition–diet (Carlin et al., 2017); a contributor to the social environment (Kepper et al., 2019) or vice versa (Chaudhury et al., 2016; Mahmood et al., 2012). In some research, both physical and social environments are identified as determinants of physical activity, whereas individual level factors, including age and sex, are consistently correlated with physical activity (Bauman et al., 2012).

Older women

Age is regarded as a homogeneous entity in many studies. The literature is peppered with varying age ranges, inconsistent older age cut-off criteria, and non-uniform age disaggregation (World Health Organisation, 2020, p.19). To add to this complexity, perceptions of ageing and the experiences of ageism can negatively or positively influence the translation of physical activity in later life (Massie & Meisner, 2019). Ageing expectations (Meisner et al., 2013) and the “meanings of aging” (Dionigi et al., 2011) held by older women also influence the relationship of ageing and physical activity. For example, in their examination of physical activity and successful ageing, Dogra and Stathokostas (2012) and Meisner et al., (2010) found that moderately active, least sedentary older Canadians were more likely to age successfully.

In much of the research into physical activity, older women and men are grouped collectively as adults or older adults. However, for Bengoechea et al. (2006), there are gender differences in the perceived correlates of physical activity. They advise treating gender as a potential moderator of the link between the perceived environment and physical activity. Riva et al., (2007) also favour a gender-specific approach to policies and environmental interventions to promote physical activity. Conversely, in their systematic review of the individual contributors to physical activity, Notthoff et al., (2017) were unable to discern definitive gender differences in activity levels, but concluded that for some types of physical activity, gender could be relevant.

Nonetheless, there is a growing evidence base linking various socio-demographic factors such as age and gender (among others), with physical activity. At present, few of these studies are situated in rural areas.

Rural areas

Rural and remote areas are frequently characterised by assumptions of uniformity (Dollman et al., 2016, p. 2), but as Lavergne and Kephart (2012) observe, arriving at a definition that accounts for within and between community differences is notoriously difficult. However, a new Remoteness Index that allows “better differentiation, description and understanding of the very different realities of diverse rural communities” (Leclerc, 2021, pp. 5–6) was lately developed in Canada. The index is predicated on the relative remoteness of communities, and consists of five categories: easily accessible, accessible, less accessible, remote, and very remote areas (Subedi et al., 2020, p. 4), all based on the distance from large urban conurbations–Census Metropolitan Areas (CMAs) and Census Agglomerations (CAs). An alternative classification system is also in use in Canada. This is based on Metropolitan Influenced Zones (MIZ) that account for the flow of workers commuting to nearby urban areas: a Strong MIZ corresponds to 30–50 per cent commuter flow, Moderate MIZ to 5–30 per cent, and Weak MIZ to 0–5 per cent movement of commuters (Lavergne & Kephart, 2012, p. 3). Additionally, some researchers describe rurality as a continuum (Umstattd Meyer et al., 2016, p. 2).

Further variance is evident when rurality is juxtaposed with physical activity. The environment associated with physical activity (Duncan et al., 2005; Fleig et al., 2016) may not be clearly identified, and/or it is broadly applied to all rural areas. A one size fits all approach to rural settings is debunked by two recent Canadian studies. In Québec, Levasseur et al., (2020) found that different environmental characteristics influenced older adults participation in social activities (and concomitantly, physical activity). These findings affirm Naud et al.’s (2019) earlier study examining locational (region) and socio-demographic (population size) effects on barriers and community activity participation by older Canadian women and men.

Additional reviews signalled the under-representation of older adults and residents of rural areas in Canada (Orstad et al., 2017, p. 918), especially in relation to “the interplay between physical activity, psychosocial cognitions, and perceived characteristics of the built environment.” (Fleig et al., 2016, p. 1368).

The challenges involved in deriving definitive conclusions from a dissimilar evidence base are articulated by Nykiforuk et al., (2018, p. 430) in their review of physical activity in rural, remote and northern settings in Canada. Despite multiple definitions, designations, and relationships, the authors underscore “the importance of understanding how geographical differences can influence relationships between the built environment and health-related behaviours” (Nykiforuk et al., 2018 p. 430), and by extension, physical activity. Consequently, a scoping review was designed to investigate what is known about physical activity among older women living in rural Canada.

Methods

The scoping review was developed according to the guidance documented in the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis (Aromataris & Munn, 2020). It was also informed by the original methodology outlined by Arksey and O’Malley (2005), and subsequently updated by Levac et al., (2010). For referential consistency and clarity, the following nomenclature was adopted: a study refers to primary academic research, whereas articles refer to all the evidence included in the review (studies, reviews, and reports).

Since physical activity among older Canadian women living in rural and remote areas is significantly under-researched, an exploratory scoping review was chosen as the preferred methodological approach, rather than a systematic review or a realist review (Munn et al., 2018). Furthermore, quality checks are not required in scoping reviews (as in systematic reviews) (Peters et al., 2020, pp. 410–411), and unlike systematic reviews, scoping reviews summarise rather than synthesise the included literature (Peters et al., 2020, p. 421).

Scoping reviews are conducted for various reasons (Munn et al., 2018): in this case, the review aimed to provide an overview of the literature related to physical activity among older women living in rural Canada. Here, Levac et al.’s (2010) recommendation to combine a broad research question with a clearly articulated (narrow) scope of inquiry was followed. Hence, the research question has an intentionally wide envelope (Peters et al., 2020, p. 410): to identify what is known about physical activity among older women living in rural Canada.

Search Strategy

To facilitate a comprehensive scan, the preliminary search parameters were informed by the Population, Concept, Context (PCC) mnemonic (Peters et al., 2020, p. 415), and considered an expansive range of selection criteria, including type of evidence, purpose, socio-demographic information, geographic setting/location, results, conclusions, and implications (if provided). Although a three-phase search strategy was implemented in accord with the JBI guidance (Aromataris & Munn, 2020), the search process itself was highly iterative.

Phase one

An initial, limited search of the PubMed and PsychInfo online databases was conducted to ascertain the relevance of the proposed key words and resultant articles. This preliminary pilot identified numerous studies and reviews situating physical activity among older adults in urban settings, but few exclusively focused on older women, and especially in rural areas, and/or in Canada. It also reaffirmed the conclusions of earlier work, and confirmed the need for research about older women, and Canadian rural contexts.

Phase two

The second phase consisted of an extensive search of eight online databases, outlined in the flow chart (Fig. 1) modelled on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018). These searches were performed between the months of January to May 2022, by the author. Searches were delimited to: published, peer-reviewed, full-text, academic research (studies and reviews), conducted from 2000 to 2020, in English. To optimise a wide corpus, the following key word search terms were used: “older age* AND women*”, “rural areas”, “physical activity”. Additional searches for grey literature (reports, presentations, editorials, and commentaries) were conducted via governmental and organisational websites.

Fig. 1
figure 1

Search Strategy

Full size image

Phase three

Related articles obtained from the online search, and reference lists from selected reviews, studies, and reports were searched for additional sources. A key journal (Journal of Aging and Physical Activity), not available electronically to the author, was also hand-searched. During this phase, the inclusion criterion for the applicable time frame was expanded to the present (2000 to 2022) to allow for recently published literature, with the associated caveat that any Covid-related articles were excluded. (The author felt that potential results could be distorted by the specific conditions and contexts of the Covid pandemic).

Evidence Screening and Selection

Again, this was a highly iterative process, centred on the PCC criteria. The purposeful and repetitious sifting and re-screening of the article pool strengthened methodological rigour and contributed to the consistency of the final selection. 3,314 initial articles were filtered by title and abstract for relevance; with 161 duplicates and 2500 non-Western situated articles removed. Articles were also eliminated if they associated physical activity with specific medical conditions and/or health limitations. Full text screening with additional selectivity (North America, not interventions; leisure and recreational physical activity, not structured programmes; community-dwelling older adults, not residential care) refined the selection further. Physical activity interventions and articles relating to special populations (Indigenous, linguistic, religious, and immigrant groups) were also excluded on the grounds that their purpose and contexts exceeded the scope of the review, while seasons and weather; and travel and transportation, were retained because of their overall relevance to rural areas.

A final sort resulted in 33 articles focused on rural settings and Canadian contexts, and included academic studies, reviews, and reports.

Because the literature search retrieved a low number of articles directly related to physical activity and older women living in rural Canada, some criteria slippage occurred (Baerta et al., 2011, p. 472; Nykiforuk et al., 2018, p. 421). Even though a wider age range (ages less than 65 years) comprised a number of the included articles, the resultant boundary blurring was carefully controlled by ensuring that the main selection criteria were priorised–for example, significantly more women than men in a mixed sample. It is also important to note that many of the articles sampling both women and men were population-level surveys. In all instances, only findings relevant to rural Canada were included in the results. (The term rural areas is used in preference to finer grained delineations in order to accommodate the full complement of articles related to rural Canada).

Data Extraction

The results are prefaced by an overview of the articles, together with a composite demographic profile. They are then presented in seven tables, followed by a detailed summary. Tables one and two provide a record of the characteristics of research studies only, while Tables three to seven feature key findings and related implications across all articles (studies, reviews, and reports). For convenience, the articles are categorised and sequenced in descending order: in Tables one and two (research studies)—at first, studies with an exclusively rural focus, then studies focused on both rural and urban settings; and for Tables three to seven (all articles)—studies (as above), reviews with a Canada-only focus, followed by reviews covering Canadian and international foci, and lastly, reports (all of which relate to Canada). To reduce the risk of interpretative bias, the results and implications recorded in Table 3, Table 4, Table 5, Table 6, Table 7 were quoted directly from the articles where feasible. Summaries (following) were then compiled to complement and expand the tabular results.

Table 1 Characteristics of Research Studies Included in the Review
Full size table
Table 2 Results From Each Article
Full size table
Table 3 Results From Each Article
Full size table
Table 4 Results From Each Article
Full size table
Table 5 Results From Each Article
Full size table
Table 6 Results From Each Article
Full size table
Table 7 Results From Each Article
Full size table

Results

Overview of the Articles

In general, the articles cover a broad spectrum of topics, approaches, socio-demographic indicators, contexts, and measures of physical activity.

The 19 research studies included qualitative and quantitative methods, with the five rural only studies employing a qualitative approach, and the remaining 12 studies are predominantly population based, employing quantitative methods. There is a relatively even spread across published dates, and although only two studies focus on women exclusively, 14 include older ages (65 years and over). A range of contextual indicators and physical activity measures are also utilised.

Eight reviews are included as well. As a group, they demonstrate considerable dissimilarity, encompassing an archival review, one scoping review, two systematic reviews, three literature reviews, and an international comparison. Their foci too, vary from neighbourhood built environment and walking, to climate change impacts on health and wellbeing. Only one review was conducted prior to 2016, and not all reviews identify the number of included studies.

Four of the six reports are profiles compiled from Statistics Canada (national) data, with the remaining two situated at a provincial level. Again, the topics are relatively disparate, and extend from the transportation habits of older Canadians, to the socio-demographics of women in rural and remote communities.

Demographic Profile

Older adults aged 65 years and over comprised approximately 13.7 per cent of the Canadian population in 2006. The geographic distribution of these older Canadians varied across provinces, with the highest numbers located in Atlantic Canada (New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island), Quebec, Saskatchewan, and British Columbia. In 2009, 22 per cent of older Canadians lived in rural and remote areas (Turcotte, 2012).

Although 68.5 per cent of women in Canada resided in metropolitan areas, the socio-demographic profile of women in rural and remote regions was characterised by population ageing–the average (median) ages of females in urban areas was 40.9 years and increased to 44.7 years in rural settings (Leclerc, 2021).

Age, gender, and locality also impacted the level of leisure-time physical activity in Canada. Keats et al., (2017) indicated that 82 per cent of Canadian adults (18–79 years) were physically inactive, particularly older women living in rural areas (Amini, 2022; Barnett et al., 2008; Gilmour, 2007; Yip et al., 2016). Again, provincial differences were noted, especially an east-to-west gradient, with older women in western Canada about twice as likely to be physically active than those in the Atlantic provinces (Gilmour, 2007; Kaplan et al., 2001).

Summary of the Results

Two frames of reference were chosen to summarise the results: namely, a social-ecological framework (Sallis et al., 2006) for findings, and Canada’s “Let’s Get Moving” (Federal Provincial and Territorial Physical Activity Framework Development Steering Committee, 2018) common vision for the implications of these findings.

Findings

Many authors advocate and adopt a multilevel approach to account for the various contributors to older adults physical activity (Pan et al., 2009; Rhodes et al., 2007)–in many instances, their choice relates to a social-ecological framework. In general, this framework outlines different layers of influence for the realisation of physical activity, including individual, social, organisational, societal, and political levels. It also accounts for the interconnectivity between the layers.

Individual/person related level of influence

For older women, physical activity offered many benefits, namely: enjoyment (Graham & Connelly, 2013; Pelletier et al., 2021) and fun (Leipert et al., 2014); maintain independence (Graham & Connelly, 2013) and ability to continue living in own home (Schmidt et al., 2016); wellbeing (Leipert et al., 2014); physical, social, and mental health (Mair et al., 2019); psychosocial stress reduction, social support, intellectual stimulation (Paluck et al., 2006); resiliency (Leipert et al., 2014); personal growth and confidence (Leipert et al., 2014; Pelletier et al., 2021); opportunities for socialisation (Graham & Connelly, 2013; Leipert et al., 2014); catalyst for engaging with other activities (kayaking, hiking, skiing) (Leipert et al., 2014). It also helps the women manage health problems (Dechaine & Witcher, 2007; Graham & Connelly, 2013), and cope with long dark cold winters (Leipert et al., 2014).

Although walking was the most common activity (Dechaine & Witcher, 2007; Farkas et al., 2019; Gilmour, 2007), work (domestic chores and physical labour) (Witcher et al., 2007), gardening and home repairs) (Belon et al., 2014), singing and motor cycling (Dechaine & Witcher, 2007) were regarded as physical activity as well. The related perception that “exercise is movement” (Graham & Connelly, 2013, p. 336), encompassed utility activity and leisure (Graham & Connelly, 2013), and a balance of activities (Paluck et al., 2006). Some women pursued a proactively active living approach to their daily activities (Dechaine & Witcher, 2007), whereas others viewed physical activity as work (Witcher et al., 2007), with leisure regarded as a foreign concept (Witcher et al., 2016). Additionally, older women were less likely to follow active, versus inactive, trajectories of physical activity (Barnett et al., 2008).

Participation in physical activity was facilitated by previous experience (Graham & Connelly, 2013); active role models (Plotnikoff et al., 2004); availability of resources (curling rink, walking club, golf links) (Paluck et al., 2006); encouragement by others (family and friends) (Dechaine & Witcher, 2007); and social inclusion (Yip et al., 2016).

Alternatively, many of the women faced considerable restrictions to their engagement with physical activity, including barriers related to: the individual– busyness (work), no discretionary time (Dechaine & Witcher, 2007; Witcher et al., 2016), and a cautious “take it easy” approach to activity (Schmidt et al., 2016; Witcher et al., 2016, p. 122); health status–scepticism about health benefits (Witcher et al., 2007), health challenges (pain, Plotnikhoff et al., 2004), physical and functional impairments (Schmidt et al., 2016; Spinney & Millward, 2014), fear of falling (Dechaine & Witcher, 2007; Schmidt et al., 2016), and multimorbidity (Keats et al., 2017); social environment–loneliness, social isolation (Paluck et al., 2006), social support (Pelletier et al., 2021), and family not close (Schmidt et al., 2016); physical environment–cold, ice, slush, strong winds (Dechaine & Witcher, 2007; Schmidt et al., 2016), rain, snowfall, and depth of snow (Chan et al., 2006; Chan & Ryan, 2009), winter season (Chan et al., 2006; Chan & Ryan, 2009; Gilmour, 2007; Merchant et al., 2007; Spinney & Millward, 2014), perceived safety (fear of darkness) (Dechaine & Witcher, 2007; resources–access, cost of recreation (gym, memberships, distance) (Belon et al., 2014; Pelletier et al., 2021; Riva et al., 2007; Schmidt et al., 2016), built environment (Farkas et al., 2019); and transportation–lack of transport (Dechaine & Witcher, 2007; Kipp et al., 2019), car culture (Belon et al., 2014); no driving licence (Turcotte, 2012).

Some of these characteristics present as both enablers and inhibiters of physical activity. On one hand, family members encouraged physical activity, while on the other, they adopted ageist too old (Schmidt et al., 2016) and take it easy (Witcher et al., 2016) attitudes. Similarly, car ownership allows access to distant recreation and leisure facilities, but also discourages physical activity (Belon et al., 2014). And although physical activity may be valued by the older women, in practice, “it would probably be pointless for them.” (Witcher et al., 2016, p. 121).

Social/relational related level of influence

As noted previously, engaging with other adults, such as family (Schmidt et al., 2016), peers (Belon et al., 2014), and community (Paluck et al., 2006) was a beneficial adjunct to the women’s participation in physical activity (Plotnikoff et al., 2004). The older women regarded their social interactions (intentional and as part of daily routine) (Schmidt et al., 2016) as contributing to an active mind (Paluck et al., 2006). Physical activity in a social milieu forged community connections (“curling family” Leipert et al., 2014, p. 130), and fostered inclusivity and intergenerational solidarity, strengthened relationships, and expanded social networks (Leipert et al., 2014). However, rural residents have fewer opportunities and receive less social support to be active, than residents of urban areas (Pelletier et al., 2021).

These social relations were also impacted by the local socio-cultural environment. According to Belon et al., (2016), the “sociocultural environment is a complex, dynamic construct: it encompasses the community’s social and cultural context that shapes beliefs, values, and practices, which, in turn, may foster or inhibit individual efforts to participate in physical activity.” (pp. e92-e93) Here, the older women’s opportunities to engage with leisure-time and recreational activities were often limited by age and ageist attitudes and beliefs as in Witcher et al.’s (2007, 2016) studies. The devaluing and marginalisation of non-work related activity was also adopted by some of the older women who raised concerns about the acceptability of some types of physical activity (Witcher et al., 2007). Different types of activity were ranked by the women in Graham and Connelly’s (2013) study as well.

Organisational/community related level of influence

However, participation in physical activity was reinforced by social cohesion (Yip et al., 2016), and a strong sense of belonging, investment, and ownership of the community (Graham & Connelly, 2013; Paluck et al., 2006) for the majority of the women. In fact, Yip et al., (2016) found that the association between community-level social cohesion and physical activity was approximately twice greater than the association between individual-level social cohesion and physical activity. Collectively identified as the rural way of life, these inter-relationships were instrumental in providing environments favourable to healthy lifestyles, including physical activity (Gadais et al., 2018). For example, women in local areas in small urban regions were significantly more likely to use local facilities for physical activity than women residing elsewhere (Riva et al., 2007).

Despite the importance of safe, supportive, and accessible community environments in facilitating physical activity, Schmidt et al., (2016) and Pelletier et al., (2021) suggest that facility access (social and built environmental barriers) is a challenge for rural residents. Both Paluck et al., (2006) and Skinner and McCrillis (2019) signal that adequate resources for physical activity, such as community infrastructure (access to parks and recreation facilities) and proximity to services or public transportation, may be limited in rural areas. The availability and condition of sidewalks, trails, natural spaces, and recreational resources (Belon et al., 2014; Farkas et al., 2019) underscore the mutuality between the physical environment and physical activity.

Community transportation issues are equally influential, whereby people who depend on others to provide transport are more reluctant to request travel assistance for leisure activities compared with more essential needs (Luiu et al., 2017; Turcotte, 2012). Hence, older people will utilise poor facilities and conditions in the absence of an alternative, and/or unrealistic travel distance to other facilities (Belon et al., 2014), and persevere with their activity in inclement weather (Chan et al., 2006). This determination underscores the resolve of older women to orchestrate their health and wellbeing in the face of limited resources and social outlets (Mair et al., 2019).

Society related level of influence

These interdependencies are also impacted by Canada-wide, cross-cutting influences on physical activity among older women, namely, geographic location, climate change and weather, and travel and driving. For example, Kaplan and Newsome (2001) and Merchant et al., (2007) propose that the east-to-west gradient in physical activity levels in Canada is related to a more temperate climate in British Columbia (western Canada), as well as other cultural and environmental differences (Kipp et al., 2019). Additional studies suggest that older adults in rural and remote regions are vulnerable to severe weather conditions (Chan & Ryan, 2009), and seasonal (Turrisi et al., 2021) and climatic changes (Kipp et al., 2019), with obvious implications for transportation and travel (Unsworth et al., 2021). An extensive review of unmet travel needs by Luiu et al., (2017) found that at least one-third of older people, especially women and adults 75 years old and above, were affected by limited transportation options. This finding has particular resonance for older women who are non-car drivers (Turcotte, 2012), and in a rural setting, may restrict their community engagement and participation in a range of out-of-home activities (Unsworth et al., 2021, p. e21).

Government/policy related level of influence

The comparison of the mobility patterns of older adults by Unsworth et al., (2021) attests to the complexity and interconnections embedded in providing adequate transportation and infrastructure to support active living for older adults. At a neighbourhood level, local government initiatives are critical (Dechaine & Witcher, 2007), and may involve clearing sidewalks of snow build-up and debris during winter (Belon et al., 2014), extending access to recreational facilities (Belon et al., 2014), maintaining and expanding physical activity opportunities (Paluck et al., 2006), and financial assistance and sponsorship for small community-based organisations (Paluck et al., 2006).

Governmental support at a provincial level also plays an integral part in driving physical activity in rural and remote regions. However, policy directives are not always translated into practice, as identified by Brooks-Cleator and Giles (2016) in their investigation of physical activity policy for older adults in the North West Territories of Canada. There, the political landscape is largely devoid of policies, programmes, and opportunities for older residents to participate in physical activities.

Implications

“Let’s Get Moving” (Federal Provincial and Territorial Physical Activity Framework Development Steering Committee, 2018) offers a common vision for increasing physical activity and reducing sedentary living in Canada. It is a national (except for the province of Québec) strategy that sets out six areas of focus for collaborative action: cultural norms, spaces and places, public engagement, partnerships, leadership and learning, and progress. As such, these imperatives form a fitting platform on which to summarise the implications arising from the articles selected in the review.

Focus on cultural norms

The “Let’s Get Moving” (Federal Provincial and Territorial Physical Activity Framework Development Steering Committee, 2018) strategy defines cultural norms as establishing social values and beliefs that contribute to making physical activity the default choice (p. 28), in effect, movement as a social norm. This socio-cultural perspective is reflected in some of the articles; for example, Witcher et al., (2016), who advocate for a shared understanding of what constitutes being “physically active”, and recommends aligning activity to work. Other authors stress the value of the social environment, particularly in rural settings, where residents have fewer opportunities and receive less social support to be active (Pelletier et al., 2021). In this context, social support (Belon et al., 2014; Plotnikoff et al., 2004), and individual and collective social inclusion and cohesion (Yip et al., 2016), and culturally safe and inclusive services (Amini, 2022) are vital.

Focus on spaces and places

Here, the “Let’s Get Moving” (Federal Provincial and Territorial Physical Activity Framework Development Steering Committee, 2018) emphasis on a physical movement environment to support all forms of community is echoed in Leipert et al., (2014) and Mair et al.’s (2019) descriptions of curling and curling clubs in rural Canada. “Pride about the curling facilities, rural abilities, and rural communities” (Leipert et al., 2914, p. 137) underscores the synergy between the physical environment and activity, and encompasses neighbourhood walkability, land use, proximity to destinations (Farkas et al., 2019), and safe and attractive infrastructures (Belon et al., 2014; Gadais et al., 2018). The natural environment too, can facilitate or inhibit physical activity (Turrisi et al., 2021), with Chan & Ryan (2009), Kaplan et al., (2001), and Merchant et al., (2007) demonstrating that geography, seasons, and weather significantly affect activity in rural areas.

Focus on public engagement

Mair et al., (2019) conclude that many options for physical activity are constrained by various conditions of rurality (choice, access, distance), with the use of recreational facilities influenced by local area characteristics, independent of the characteristics of local population (Riva et al., 2007). For Belon et al., (2014) and Unsworth et al., (2021), rural and remote regions are also shaped by the socio-cultural, economic, and political environments, and revealed by the existing expertise of individuals and communities.

Focus on partnerships

Partnership working in rural areas may be characterised by Mair et al.’s (2019) representation of curling clubs as “making health through self-care and community-care.” Along similar lines, Brooks-Cleator and Giles (2016) recommend that multi-sectoral organisational partners collaborate with older adults at all stages of the policy cycle to develop age-friendly policies in Canada’s North West Territories. And according to Skinner and McCrillis (2019), and Unsworth et al., (2021), community and transport mobility, community participation, and quality of life are important collaborative considerations for transportation policies at a larger regional level.

Focus on leadership and learning

Building robust leadership and learning networks around physical activity among older adults living in rural Canada rest on a long-lens historical perspective (Witcher et al., 2007) of activity patterns (Luiu et al., 2017). These may incorporate socio-economic and demographic factors (Keats et al., 2017); positive policy interventions (Spinney & Milward. 2014), embracing political and socio-cultural spheres of action (Gadais et al., 2018); research exploring gender effects, and causal associations between physical activity, multimorbidity, and health outcomes (Keats et al., 2017); and finally, the sustainability of rural communities (Leipert et al., 2014) in relation to accessibility, travel choice and lifestyle, and ageing in place (Luiu et al., 2017). And according to Leipert et al., (2014) and Mair et al., (2019) curling clubs are exemplars of physical activity leadership and learning opportunities in small rural communities.

Focus on progress

Although the remit of this review is not to comment on “what is working” (progress) per se, this summary provides selected insights about the implications of physical activity in rural populations, specifically older women, in Canada. These implications are most relevant to the Let’s Get Moving (Federal Provincial and Territorial Physical Activity Framework Development Steering Committee, 2018) focus areas related to socio-cultural norms, community (public) engagement, and the partnership working involved in supporting physical activity in rural communities. Leadership and learning opportunities too, are often embedded in local activity-based organisations.

Discussion

To recapitulate, “what is known” about physical activity among older women living in rural Canada? This scoping review reveals that physical activity among older women living in rural Canada is influenced by an array of layers, contexts, conditions, and environments, with outcomes dependent on the relative mixture of personal, relational, community, societal, and governmental factors. Many articles indicate, that in general, the older women enjoy physical activity, and are committed to creating and maintaining a healthy and active lifestyle, and support their local rural community to enable these activities– in effect, “making health through self-care and community- care.” (Mair et al., 2019, p. 97)

A number of articles report social and physical environment challenges to the realisation of physical activity among older women in rural areas. While the social environment can proscribe the physical activity of some women through ageist and age related attitudes and restrictive socio-cultural norms, social support from family and community members mitigates against these constraints. Physical infrastructure, geography, climate (seasons and weather), as well as transportation and policy issues may also impede the physical activity opportunities of older women living in rural areas.

Some of the problems related to sustaining physical activity and recreation resources in small rural communities are partly addressed through the implications and recommendations presented in the articles. Among others, these suggestions relate to leadership and learning opportunities, community (public) engagement, and the partnership working involved in supporting physical activity in rural areas.

The purpose of this review is exploratory, so these findings paint a very broad canvas at best, and as such, do not directly relate to specific rural communities and contexts across Canada or internationally. And since this review is delimited to older women in a rural setting, age, gender, and location (independently and together), have significant and very divergent effects depending on orientation and context.

These differences are evident in the wider literature. For instance, rurally referenced research in the USA often embraces older women identifying with different ethnic groups, such as African Americans, Hispanic/Latinos, Native and Alaskan Americans, as in the early studies by King et al., (2000) and Wilcox et al., (2000). Here, it is important to acknowledge an equivalent cadre of Canadian studies related to physical activity in older Indigenous (Hopping et al., 2010; Kirby et al., 2007), linguistic (Imbeault et al., 2013), religious (Bassett et al., 2004), and immigrant (Salma et al., 2020; Tong et al., 2018) adults. (As indicated in the methods section, the inclusion of this literature is outside the scope of this review).

Similarly, by limiting the review to rural areas, many insightful studies pertaining to physical activity in Canada were not considered. These investigations examine various contributors to physical activity, but in general, not as a/n unitary concept. However, one example of cross-cutting related research is Hanson and Hildebrand’s (2011) inquiry into the unmet travel needs of older Canadian drivers without a car. The authors advocate for a “community-supported, member-based rural shuttle service with volunteer and paid drivers that build on informal social networks and can provide service when friends and family are unavailable.” (p. 975). Accordingly, this proposal offers a potential solution to the ubiquitous problem of transportation provision in rural Canada. Turcotte (2012) noted that transportation is a significant barrier to older women’s participation in physical activity in general, and analogously, older Canadians’ social participation (Levasseur et al., 2015, 2020), and presents an ongoing dilemma for service provision.

A number of the articles included in this review determined that social support from family and friends promoted the women’s physical activity, but alternatively, age and ageist attitudes and restrictive socio-cultural norms held by family and community members had a dampening effect. This “support and sabotage” dichotomy was corroborated in a USA study examining how social relations promote or hinder health-related behaviours among midlife and older rural adults (Sriram et al., 2018). And in their analysis of the lived experience of older Canadians with differing gender, class, age, and health status, Rozanova et al., (2012) showed that care responsibilities, “compulsory altruism”, individual resources, engagement opportunities, and ageism limited older Canadians choices to be socially engaged in their rural community.

Many articles referenced the interconnectivity between the ambient social and physical environment and the women’s physical activity. For Ward et al., (2020), older Canadians living in northern and rural settings are “more likely to maintain physical activity when physical environments foster healthy aging and provide opportunity for social engagement.” (p. 854) And although Leipert et al., (2014) and Mair et al., (2019) emphasise the critical role that curling clubs and comparable organisations play in promoting physical activity among older women in rural Canada, they also raise the issue of adequately resourcing and sustaining rural communities to support these recreational activities. In response, and building on the seminal work of Keating et al., (2011), Brooks-Cleator and Giles (2016) propose that age friendly rural and remote communities (Public Health Agency of Canada, 2010) could provide a rurally-oriented roadmap (Jeffery et al., 2018) for governments and non-governmental organisations to promote physical activity in their jurisdictions.

Limitations

This scoping review has been conducted by only one reviewer, and as such, contravenes the recommendations of JBI among others, to use a team-based approach. Consequently, “characterization and interpretation of the included reviews were…subject to reviewer bias.” (Pham et al., 2014, p. 38) In spite of directed efforts to mitigate and manage this subjectivity (identified in the methods section), it remains a major limitation.

And as noted previously, the review was intentionally focused on older women living in rural Canada, resulting in the omission of some key areas of research, specifically physical activity interventions and in special populations. There is also a wealth of literature related to different ages, genders, locations, and types of activity (independently and together) that are not addressed in this review. Canadian articles published in the French language are also missed.

Although the review provides an overview of what is known about physical activity among older women in rural Canada to date, it is not directly generalisable or transferable to other settings and/or contexts. It was also difficult to tease out summaries of the findings and implications because of the inconsistent definitions, conceptualisations, contexts, and measures related to older women, rural areas, and physical activity across the articles.

Future Research Agenda

The extremely limited number of articles focusing on physical activity among older women living in rural Canada is a gaping hole in the research landscape. In addition to developing a foundational evidence base, there is a need to examine specific age, gender, location, and activity characteristics, contexts, and contributions independently, inter-dependently, and collectively. Further research is also required to expand the literature related to physical activity among special populations in rural areas and Canada generally, as well as interventions related to physical activity promotion in older women in rural Canada.

Conclusions

This scoping review investigated what is known about physical activity among older women living in rural Canada.

The diversity of articles included in the review reflects the multiplicity of layers, contexts, conditions, and environments that influence physical activity among older women living in rural Canada. These articles demonstrate that physical activity for the older women in these settings is dependent on an interconnected mix of personal, relational, community, societal, and governmental relationships, and underscore the critical role of the women’s social and physical environments in promoting or restraining their activity. As such, this finding resonates with the multidimensional conception of successful ageing initially proposed by Rowe and Khan (1997), and more recently augmented by Cosco et al., (2014) and Urtamo et al., (2019), among others.

In conclusion, although the review makes a contribution to the literature about physical activity among older women living in rural Canada, it reinforces Nykiforuk et al.’s (2018) “Call to Action” for further research into the genre of rurality and physical activity, especially in relation to older Canadian women.