Elsevier

Preventive Medicine

Volume 55, Issue 4, October 2012, Pages 276-284
Preventive Medicine

Review
What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies

https://doi.org/10.1016/j.ypmed.2012.07.016Get rights and content

Abstract

Objective

The objective of this study is to synthesise views and experiences of South Asian (SA) older adults in relation to exercise and physical activity (PA). It was anticipated that this work would identify barriers and facilitators that could inform interventions aimed at promoting PA among this population.

Method

A systematic review of qualitative research was conducted. Six electronic databases were searched for relevant papers published from January 2000 to October 2011. Studies were appraised and data extracted by two reviewers. A synthesis was undertaken using framework analysis. Of 26 papers read in full, 11 were included in the review.

Results

An overriding concept derived from the synthesis was the influence of empowering and disempowering contexts on PA levels of SA participants. It was supported by the following themes: communication (e.g. relying on relatives for translation of information, lack of understanding); relationships (e.g. social support from family, friends, community), beliefs (e.g. not culturally appropriate to exercise, fatalism) and environment (e.g. lack of accessible recreational areas/facilities).

Conclusions

Drawing on community resources to generate group norms appears to be important when trying to increase exercise and PA among SA older adults. Implications of the results for PA promotion and provision are discussed.

Highlights

► Poor English language proficiency is a barrier to obtaining accurate information. ► Relatives can be important in motivating/facilitating older adults to be active. ► Generating group norms may produce positive benefits to changing PA behaviour.

Introduction

As populations across the globe are ageing (United Nations, 2002), keeping active can be a means of preventing disease or attenuating a condition's progress when onset has occurred (DH (Department of Health), 2009a, WHO, 2008), limiting healthcare resource use and preserving quality-of-life as a consequence. Those reaching retirement may be a key age group to target with PA interventions (Berger et al., 2005) given that this is a life-stage when individuals have more leisure-time. But older people may not see the benefits of PA for them and/or be unaware of opportunities for keeping active (Myers, 1999). They can also regard ‘slowing down’ as a natural part of ageing and, therefore, be unmotivated to exercise (Tierney et al., 2011a). This may partly explain the high percentage of inactive older adults (WHO, 2009). In England, only 19% of 65–74 year-olds and 6% of people aged 75 + meet recommended targets of at least 150-minutes of moderate intensity activity over a week (NHS Information Centre, 2008). Levels are even lower for minority ethnic groups (NHS Information Centre, 2006).

Sedentary behaviour is common among South Asians (SAs) compared to their white European peers (Hayes et al., 2002, Yates et al., 2010). For example, data from the Health Survey for England found they were 60% less likely than Caucasians to meet government recommendations for PA (Williams et al., 2011). Likewise, a systematic review by Fischbacher et al. (2004) examined PA levels among SAs compared to the general UK population and noted that rates were 50–75% less for the former. These authors comment on the lack of objective measures of PA used within included studies, which tended to be assessed via self-report questionnaires. Nevertheless, it does seem that PA is low among SAs, a group experiencing greater rates of coronary heart disease (CHD), stroke and type-2 diabetes (Bhopal, 2002, Gill et al., 2007, Hayes et al., 2002, Yates et al., 2010). Therefore, encouraging PA in SA communities remains a public health priority.

Healthcare professionals could play a role in promoting PA at every opportunity when interacting with patients, but this requires an understanding of how individuals experience recommendations to be active. We know that culture and ethnicity influence health and behaviour (Gill et al., 2007, Gupta, 2010). Given SAs increased risk of vascular problems and tendency to be sedentary, it is important to ensure that interventions are culturally sensitive by understanding experiences of the target population.

A synthesis of qualitative studies has become an important means of informing health-related policy and practice so that the needs and preferences of patients remain central to any discussion about treatments and/or service redesign (Facey et al., 2010, Ring et al., 2011). Moreover, there is an increasing recognition that qualitative studies can contribute to and enhance decision-making by presenting data on issues not explained by quantitative studies, thereby complementing traditional systematic review methods (Flemming, 2007, Noyes et al., 2008).

The purpose of a qualitative synthesis is to produce larger interpretive representations of studies examined (Barroso et al., 2003). We were interested in exploring the experiences of SA older adults reported in published papers to try and understand why they may or may not undertake PA to inform future development of interventions. This type of information is best collected using qualitative research as quantitative methods do not allow for an in-depth consideration of barriers and enablers that are important to participants.

No qualitative systematic reviews have focussed on psychological, social and organisational factors influencing uptake and maintenance of PA among SA older adults (≥ 60 years). We felt an older age group may have particular concerns not experienced by younger individuals that may be important to contemplate when developing interventions. The synthesis aimed to identify:

  • 1.

    beliefs regarding uptake of and adherence to PA;

  • 2.

    culturally appropriate approaches to increase uptake and adherence to PA;

  • 3.

    inter, intra, community and organisational factors influencing PA.

Section snippets

Search strategy and selection criteria

The following databases were searched for the literature published between January 2000 and October 2011: BNI, CINAHL, EMBASE, Medline, PsycINFO and SPORTSDiscus. We used terms relating to age, ethnicity, PA and qualitative methods (Box 1). We tried to be as inclusive as possible with initial searches to avoid overlooking relevant studies. Bibliographies of identified papers were examined for additional references. Primary inclusion criteria were qualitative research with a SA sample (first,

Results

From 535 references identified via databases, 11 papers, reporting on 10 separate studies, were included (Fig. 1), key characteristics of which are outlined in Table 1. Quality scores (out of 28) ranged from 20 to 25. Investigations were conducted in Canada and the UK. Participants included SA men and women with the following conditions who were advised to undertake PA to improve their health: CHD (Bedi et al., 2008, Darr et al., 2008, Galdas et al., 2011, King et al., 2006, Webster et al., 2002

Themes

After reading included papers on several occasions, charting data and examining these charts, several figures were produced to explain the data derived from studies. This resulted in the overarching conceptual framework of empowering and disempowering contexts influencing activity levels among this population group. It was felt that this best incorporated all data, providing a useful and accessible means of depicting the synthesised papers. Empowering and disempowering contexts were located

Discussion

This synthesis of qualitative studies has identified four themes influencing PA among SA adults, each contributing to the overarching concept of disempowering and empowering contexts. It is acknowledged that several of the issues raised in reviewed papers could apply to a generic population. For example, perceived inability to be active due to ageing is not unique to SA older adults (Tierney et al., 2011b). However, factors were recognised within the synthesis specific to SA older adults (Box 2

Conclusion

Synthesising qualitative data relating to people's views and experiences can assist in guiding the development of interventions to increase PA. The review suggested that practitioners should provide an advice based on an understanding of the potential barriers and enablers experienced by SA older adults. Developing collectivist approaches to promote external motivation may prove helpful. Support from family, friends and community groups, appears to enable these older adults to become active and

Conflict of interest statement

The authors declare there is no conflict of interest.

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