The journal of nutrition, health & aging

, Volume 22, Issue 4, pp 541–548 | Cite as

“Feeling More Self-Confident, Cheerful and Safe”. Experiences from a Health-Promoting Intervention in Community Dwelling Older Adults — A Qualitative Study

  • Åsa von Berens
  • A. Koochek
  • M. Nydahl
  • R. A. Fielding
  • T. Gustafsson
  • D. R. Kirn
  • T. Cederholm
  • M. Södergren



Studies show that regular exercise in combination with nutritional support can be effective in managing sarcopenia, which is age-related involuntary loss of skeletal muscle mass and strength. Qualitative investigations of participants’ experiences from interventions in this domain are scarce. In this study, we explored older persons’ experiences from an intervention designed to prevent sarcopenia, with the aim of capturing the participants’ thoughts and opinions.


A qualitative study embedded in the multicenter randomized clinical trial The Vitality and Vigor in the Elderly study, VIVE2. Focus group interviews were conducted. Manifest and latent content analyses were performed.


Community dwelling older adults (n=20) 71-86 years of age with minor limitations in mobility.


The experiences from the intervention were categorized and interpreted in one overall theme “Feeling more self-confident, cheerful and safe”. The theme encompasses the categories psychological effects of participating in the intervention, physical effects of participating in the intervention, the importance of social support and the importance of a tailored set-up. The participants described their motives for participating in the intervention as being based on concerns regarding the negative health effects of continuing a sedentary lifestyle, difficulties of getting started on their own and lack of confidence in accomplishing change on their own. Participants also expressed that one main objective for participating was to lose weight.


In this study we have captured the experiences of older adults with minor mobility limitations who participated in a lifestyle intervention. The experiences are interpreted in one overall theme “Feeling more self-confident, cheerful and safe”. The central understanding of the participants’ experiences was that the intervention affected them in several ways, both psychologically and physically, and that supporting factors included the social support, which became a prerequisite for success. A noticeable finding was the discrepancy between the motive of the participants, to lose weight, and the aim of the study, to improve muscle function. The expectation to lose weight seems to reflect what is commonly known as to be healthy. To our knowledge, at least in Sweden, there are no campaigns or public information highlighting the risks of sarcopenia and the complex issue of if, and when weight loss is desirable for older individuals. This finding highlights the importance of providing such information to this target group. The findings in this study provide valuable knowledge for research teams, practitioners and decision makers when designing and setting objectives for health-promoting interventions for older individuals.

Key words

Older adults health-promoting intervention qualitative nutrition exercise 


  1. 1.
    United Nations DoEaSA, Population Division, 2013. World Population Ageing 2013. Report. Department of Economic and Social Affairs, Population Division. Accessed 4. April 2016.Google Scholar
  2. 2.
    Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote “Active Aging”. The Gerontologist 2016;56:S268–S280. doi: 10.1093/geront/gnw031CrossRefPubMedGoogle Scholar
  3. 3.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423. doi: 10.1093/ageing/afq034CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M. Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and Consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc 2011;12:249–256. doi: 10.1016/j.jamda.2011.01.003CrossRefPubMedGoogle Scholar
  5. 5.
    Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, Slomian J, Buckinx F, Bruyère O. Quality of life and physical components linked to sarcopenia: The SarcoPhAge study. Exp Gerontol 2015;69:103–110. doi: 10.1016/j. exger.2015.05.003CrossRefPubMedGoogle Scholar
  6. 6.
    Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr 2012;31:652–658. doi: 10.1016/j.clnu.2012.02.007CrossRefPubMedGoogle Scholar
  7. 7.
    Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, Chen L-K, Fielding RA, Martin FC, Michel J-P, Sieber C, Stout JR, Studenski SA, Vellas B, Woo J, Zamboni M, Cederholm T. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014;43:748–759. doi: 10.1093/ageing/afu115CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    International Working Group on S. Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and Consequences. J Am Med Dir Assoc 2011;12:249–256. doi: 10.1016/j.jamda.2011.01.003CrossRefGoogle Scholar
  9. 9.
    Denison HJ, Cooper C, Sayer AA, Robinson SM. Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin Interv Aging 2015;10:859–869. doi: 10.2147/CIA.S55842PubMedPubMedCentralGoogle Scholar
  10. 10.
    Volkert D. The role of nutrition in the prevention of sarcopenia. Wien Med Wochenschr 2011;161:409–415. doi: 10.1007/s10354-011-0910-xCrossRefPubMedGoogle Scholar
  11. 11.
    Devereux-Fitzgerald A, Powell R, Dewhurst A, French DP. The acceptability of physical activity interventions to older adults: A systematic review and metasynthesis. Soc Sci Med 2016;158:14–23. doi: 10.1016/j.socscimed.2016.04.006CrossRefPubMedGoogle Scholar
  12. 12.
    McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 2016;17:567–580. doi: 10.1007/s10522-016-9641-0CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bandura A. Self Efficacy: Toward a unifying theory of behavioral change. Adv Behav Res Ther 1978;1:139–161.CrossRefGoogle Scholar
  14. 14.
    Franco MR, Tong A, Howard K, Sherrington C, Ferreira PH, Pinto RZ, Ferreira ML. Older people’s perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature. Br J Sports Med 2015;49:1268–1276. doi: 10.1136/bjsports-2014-094015CrossRefPubMedGoogle Scholar
  15. 15.
    Kirn DR, Koochek A, Reid KF, von Berens A, Travison TG, Folta S, Sacheck J, Nelson M, Liu C, Phillips E, Aberg AC, Nydahl M, Gustafsson T, Cederholm T, Fielding RA. The Vitality, Independence, and Vigor in the Elderly 2. Study (VIVE2): Design and Methods. Contemp Clin Trials 2015; doi: 10.1016/j.cct.2015.06.001Google Scholar
  16. 16.
    Patton MQ. Qualitative evaluation and research methods. In: Qualitative reserach and evaluation methods 3d edition. Sage, Beverly Hills, CA, 1990;pp. 169–186Google Scholar
  17. 17.
    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. Sage Publications, Thousand Oaks, Calif 2009.Google Scholar
  18. 18.
    Kitzinger J. Qualitative Research: Introducing focus groups. BMJ 1995;311:299–302. doi: 10.1136/bmj.311.7000.299CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Strauss A.L. CJM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Sage Publications Inc., Thousand Oaks, California, 1998.Google Scholar
  20. 20.
    Krippendorff K. Content analysis: an introduction to its methodology. 3rd ed. SAGE, Thousand Oaks, Calif;London; 2013.Google Scholar
  21. 21.
    Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105–112. doi: Scholar
  22. 22.
    Health ISaSDaDoEaG. OpenCode 4.0. Department of Public Health and Clinical Medicine, Umeå University, Sweden. Accessed 1. july 2015.Google Scholar
  23. 23.
    Al Snih S, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med 2007;167:774–780. doi: 10.1001/archinte.167.8.774CrossRefPubMedGoogle Scholar
  24. 24.
    Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. JAMA 2013;309:71–82. doi: 10.1001/jama.2012.113905CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Roy M, Payette H. The body image construct among Western seniors: a systematic review of the literature. Arch Gerontol Geriatr 2012;55:505–521. doi: 10.1016/j. archger.2012.04.007CrossRefPubMedGoogle Scholar
  26. 26.
    Mathus-Vliegen EM. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 2012;5:460–483. doi: 10.1159/000341193CrossRefPubMedGoogle Scholar
  27. 27.
    Schieman S, Pudrovska T, Eccles R. Perceptions of body weight among older adults: analyses of the intersection of gender, race, and socioeconomic status. J Gerontol B Psychol Sci Soc Sci 2007;62:S415–423.CrossRefPubMedGoogle Scholar
  28. 28.
    Clarke LH, Korotchenko A. Aging and the Body: A Review. Can J Aging 2011;30:495–510. doi: 10.1017/s0714980811000274CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Williams SJ. Theorising class, health and lifestyles: can Bourdieu help us? Sociol Health Illn 1995;17:577–604. doi: 10.1111/1467-9566.ep10932093CrossRefGoogle Scholar
  30. 30.
    Lee LL, Arthur A, Avis M. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Int J Nurs Stud 2008;45:1690–1699. doi: 10.1016/j.ijnurstu.2008.02.012CrossRefPubMedGoogle Scholar
  31. 31.
    Mendoza-Ruvalcaba NM, Arias-Merino ED. «I am active»: effects of a program to promote active aging. Clin Interv Aging 2015;10:829–837. doi: 10.2147/CIA.S79511CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kosteli MC, Williams SE, Cumming J. Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach. Psychol Health 2016;31:730–749. doi: 10.1080/08870446.2016.1143943CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Mullen SP, McAuley E, Satariano WA, Kealey M, Prohaska TR. Physical activity and functional limitations in older adults: the influence of self-efficacy and functional performance. J Gerontol B Psychol Sci Soc Sci 2012;67:354–361. doi: 10.1093/ geronb/gbs036CrossRefPubMedGoogle Scholar
  34. 34.
    Rejeski WJ, King AC, Katula JA, Kritchevsky S, Miller ME, Walkup MP, Glynn NW, Pahor M. Physical activity in prefrail older adults: confidence and satisfaction related to physical function. J Gerontol B Psychol Sci Soc Sci 2008;63:19–26.CrossRefGoogle Scholar
  35. 35.
    McAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. Exerc Sport Sci Rev 2000;28:85–88.PubMedGoogle Scholar
  36. 36.
    Hardcastle S, Taylor AH. Looking for More than Weight Loss and Fitness Gain: Psychosocial Dimensions among Older Women in a Primary-Care Exercise-Referral Program. J Aging Phys Act 2001;9:313–328. doi: 10.1123/japa.9.3.313CrossRefGoogle Scholar
  37. 37.
    Killingback C, Tsofliou F, Clark C. Older people’s adherence to community-based group exercise programmes: a multiple-case study. BMC Public Health 2017;17:115. doi: 10.1186/s12889-017-4049-6CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Hartley SE, Yeowell G. Older adults’ perceptions of adherence to community physical activity groups. Ageing and Society 2015;35:1635–1656. doi: 10.1017/ s0144686x14000464CrossRefGoogle Scholar
  39. 39.
    Iliffe S, Kharicha K, Harari D, Swift C, Gillmann G, Stuck AE. Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. Br J Gen Pract 2007;57:277–282.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Shankar A, McMunn A, Demakakos P, Hamer M, Steptoe A. Social Isolation and Loneliness: Prospective Associations With Functional Status in Older Adults. Health Psychol 2016; doi: 10.1037/hea0000437Google Scholar
  41. 41.
    Dahlberg L, Andersson L, McKee KJ, Lennartsson C. Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging & Mental Health 2015;19:409–417. doi: 10.1080/13607863.2014.944091CrossRefGoogle Scholar
  42. 42.
    Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C. Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 2014;54:599–610. doi: 10.1093/geront/gnt075CrossRefPubMedGoogle Scholar
  43. 43.
    Kitzinger J. The methodology of Focus Groups: the importance of interaction between research participants. Sociol Health Illn 1994;16:103–121. doi: 10.1111/1467-9566.ep11347023CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • Åsa von Berens
    • 1
  • A. Koochek
    • 1
  • M. Nydahl
    • 2
  • R. A. Fielding
    • 3
  • T. Gustafsson
    • 4
  • D. R. Kirn
    • 3
  • T. Cederholm
    • 1
  • M. Södergren
    • 5
  1. 1.Department of Public Health and Caring Sciences, Clinical Nutrition and MetabolismUppsala UniversityUppsalaSweden
  2. 2.Department of Food, Nutrition and DieteticsUppsala UniversityUppsalaSweden
  3. 3.Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonUSA
  4. 4.Department of Laboratory MedicineKarolinska InstitutetStockholmSweden
  5. 5.Department of Neurobiology, Care Sciences and Society/Division of Family MedicineKarolinska InstitutetStockholmSweden

Personalised recommendations