Table 1 Effects of Community-Based Interventions Designed to Promote Physical Activity ( PA ) Among Rural / Regional Individuals Aged 65 Years or Older on Physical Activity Patterns , Physical Activity Behaviors , and Physical Function

Population aging is a global phenomenon that is accentuated in rural and regional areas when compared with metropolitan and remote areas. For example, in Australia, patterns of migration show an out-migration of younger populations to metropolitan areas, and an in-migration of retirees to rural and regional areas (Davis & Bartlett, 2008; Schofield & Earnest, 2006; Winterton & Warburton, 2011; World Health Organization, 2007). According to recent statistics, 14% (3.4 million) of Australia’s population are aged 65 years or more, and approximately 35% (1.2 million) of this demographic live outside metropolitan centers with population clusters of 100,000 or more (Australian Bureau of Statistics, 2013a). Older people are at increased risk of poor health and chronic conditions compared with younger individuals (Australian Institute of Health and Welfare, 2010a; Australian Institute of Health and Welfare, 2012). Furthermore, people living in rural and regional areas have poorer health outcomes and a higher rate of morbidity compared with those living in metropolitan areas (Australian Institute of Health and Welfare, 2008; Schofield & Earnest, 2006). This health disparity is likely to reflect the aging demographic and reduced access to health care services in rural and regional areas, exacerbated by the challenges of transport and distance, fewer local amenities and infrastructure, and health workforce shortages (Commonwealth of Australia, 2012). Thus, there is an identifiable need for health promotion services in rural and regional areas, and a particular requirement to differentiate health services between remote and rural (or regional) Australia (Commonwealth of Australia, 2012). Good health, including maintaining a healthy body weight and regular and adequate physical activity (PA), is important across the lifespan. In particular, older people rely on good health to remain independent, prevent or manage health conditions, and play an active role in their family and community life. Despite the growing body of evidence associated with healthy aging, approximately three-quarters of Australian adults aged 65–74 years are overweight or obese (Australian Bureau of Statistics, 2013b), and the majority (66.9%) self-report being sedentary or participating in low levels of exercise (Australian Bureau of Statistics, 2013b). The proportion of older people who are sedentary increases with age, from 37.5% of people aged 65–74 years to 51.7% of people aged 75–84 years, and to 66.8% for those aged 85 years and over (Australian Institute of Health and Welfare, 2010a). Furthermore, similar to other countries, older people living in rural and regional areas of Australia report higher levels of poor health risk factors than metropolitan dwellers, including being overweight or obese and undertaking little or no PA (Australian Institute of Health and Welfare, 2007, 2008; Plouffe et al., 2012; World Health Organization, 2002). There is considerable evidence supporting the role of regular PA for healthy aging. Regular PA plays a key role in the prevention and management of several chronic diseases common among older people (e.g., cardiovascular disease, diabetes, obesity, some cancers, and osteoporosis) (Hayes, Spence, Galvao, & Newton, 2009; Hordern et al., 2012; Newton, 2011; Selig et al., 2010). In addition, PA is associated with a reduced risk of premature death (Jakicic & Otto, 2006; Kruk, 2009; Warburton, Nicol, & Bredin, 2006), and has numerous psychological benefits (e.g., improved well-being and quality of life and reduced anxiety, depression, and stress) (Hamer, Stamatakis, & Steptoe, 2009; Kruk, 2009; Warburton et al., 2006). Engaging in regular PA provides additional benefits relevant for older people, which include improved cognitive functioning and a protective effect against dementia and Alzheimer’s disease (Fratiglioni, Paillard-Borg, & Winbald, 2004). Furthermore, PA programs can provide important social benefits for older people (Fox, 1999), which are likely to be particularly important for older people living in rural and regional areas, as they are at greater risk of experiencing social isolation and loneliness due to their age and location (Andrews, 2001). Therefore, the priority given to factors that motivate older people to initiate and adhere to PA programs might be different for people living in rural and regional areas. Effective Community-Based Physical Activity Interventions for Older Adults Living in Rural and Regional Areas: A Systematic Review