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Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis

The journal of nutrition, health & aging volume 17, pages 466–471 (2013)Cite this article

Abstract

Objectives

The effectiveness of community level interventions depends to a great extent on adherence. Currently, information on factors related to adherence in older adults from developing countries is scarce. Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country.

Design, setting and participants

Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects (65–67.9 years at baseline) with low to medium socioeconomic status from 10 health centers randomized to receive a physical activity intervention as part of the CENEX cluster trial (ISRCTN48153354).

Measurements

Using a multilevel regression model, the relationship between adherence (defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months) and individual, intervention-related and contextual factors was evaluated. We also conducted 40 semi-structured interviews with older adults (n=36) and instructors (n=4). Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence.

Results

Adherence to physical activity intervention was 42.6% (CI 95% 39.5 to 45.6). Depression, diabetes mellitus, percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence (p<0.05) while being retired, participation in physical activity prior to the intervention, and green areas per habitant were positively associated with adherence (p<0.05). The qualitative interviews identified three primary barriers to adherence: current health problems, lack of time due to commitments for caring for family members, and being employed, and two primary facilitators to adherence: the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others.

Conclusion

In order to enhance effectiveness of community exercise interventions, strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions.

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Abbreviations

PA:

physical activity

RCT:

Randomized Controlled Trial

PCHC:

Primary Care Health Center

GDS-15:

Yesavage Geriatric Depression Scale, 15-question version

COPD:

chronic obstructive pulmonary disease

LSHTM:

London School of Hygiene & Tropical Medicine

SD:

standard deviation

OR:

odds ratio

CI:

confidence interval

OA:

older adults

P:

physical education instructors

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Affiliations

  1. Institute of Nutrition and Food Technology, Universidad de Chile, Santiago, Chile

    Maria Luisa Garmendia & P. Eguiguren

  2. Department of Nutrition and Public Health Intervention Research, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK

    A. D. Dangour, E. Allen & R. Uauy

  3. School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile

    C. Albala

  4. Institute of Nutrition and Food Technology, Universidad de Chile, El Líbano 5524, Macul, Santiago, Chile

    Maria Luisa Garmendia

Authors
  1. Maria Luisa Garmendia
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  2. A. D. Dangour
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  3. C. Albala
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  4. P. Eguiguren
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  5. E. Allen
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  6. R. Uauy
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Correspondence to Maria Luisa Garmendia.

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Garmendia, M.L., Dangour, A.D., Albala, C. et al. Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis. J Nutr Health Aging 17, 466–471 (2013). https://doi.org/10.1007/s12603-012-0417-1

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Key words

  • Patient compliance
  • aging
  • physical activity