in physical activity, as did society’s attitude toward the ageing population. Older adults’ desire for autonomy and control conflicted with their perceptions of the limitations of the ageing body. The findings of the current review bear some similarity to those of Franco et al. (2015). The salience of environmental barriers, identification of physical barriers (e.g. pain and fear of falling), and the influence of external support was evident across both studies. However, although the review by Franco et al. (2015) provides useful insight into the barriers and facilitators older adults experience with regards to physical activity, the present study provides a higher level of interpretation and analysis. This resulted in a richer understanding being obtained that provided unique insights into underlying processes that were not recognised by Franco et al. (2015), such as older adults’ construal of physical activity as a of other more purposeful activities, how their self-identity within society affects their acceptability of physical activity, and their struggle to maintain autonomy whilst accepting the limitations of the ageing body. The present research provides a wider perspective than the review by Devereux-Fitzgerald et al. (2016) by addressing the acceptability of physical activity to older adults who are not involved in physical activity interventions and who therefore may not be motivated or willing to increase their levels of physical activity. In light of the high levels of physical inactivity in the older adult population, it is likely that a large majority of older adults constitute this group. Given this, the current review offers richer insights into physical activity in the general older adult population.
Appendix 1 Breakdown of research question and subsequent search terms using the SPIDER tool (Cooke et al., 2012) SPIDER Breakdown Search Terms S - Sample Older adults, aged 65 years and above, living independently in the community. older adult* OR elder* OR senior* OR retire* OR ag$ing P of I – Phenomenon of interest Acceptability of engagement in physical activity for older adults who are not currently active or involved in an intervention. Physical activity OR exercise OR walk* OR yoga OR danc* OR tai chi OR gym OR activities daily living D – Design Qualitative research methods, including interviews, focus groups, and open-ended questions. interview* OR focus group* OR meta-synthesis OR review* E – Evaluation Acceptability, feasibility, perceptions, attitudes, views, beliefs, barriers, motivation. acceptab* OR perception* OR attitude* OR belief* OR barrier* OR motivat* R – Research Type Qualitative studies or mixed method studies in which qualitative results are analysed and reported separately to quantitative results. qualitative OR mixed method* Appendix 2 Electronic Search Strategy (20/04/2015) AMED 1985 - April 2015 Ovid MEDLINE(R) 1946 - April Week 2 2015 PsycINFO 1806 - April Week 2 2015 older adult*.mp senior*.mp ag$ing.mp elder*.mp
Analytical Themes Roles and Self-Identity Within Wider Society Conceptual difference between OAs and health professionals’ notions of PA Perceived Vulnerability of Aging vs. Maintaining a sense of Control Descriptive Themes Personal Motivations for PA Intrapersonal Constraints for PA Perceptions of Aging Provision External Sources of Encouragement Knowledge and Beliefs about PA Influence of Environmental Factors Descriptive Sub-Themes Retain Independence Caring for Others Enjoyment Transition into Retirement Social Connectedness Cultural Value Self-Identity Competing Roles and Responsibilities Fear of Social Rejection Functional and Health Limitations Fear of Injury Laziness/Lack of Interest Incompatibility of PA and Aging Negative Attitude of Society Acceptance of Reduced Ability Negative Connotations of Labels Neighbourhood Facilities Individual Needs Transportation Financial Concerns Paucity of Information Motivating and Personable Leader Physician Advice Social and Family Support Modelling Autonomy Important Conflicting Definitions of PA General Physical and Mental Health Benefits Poor Specific Activity-Related Knowledge Health-Related Event Increases Awareness Traffic Inclement Weather Positive vs Negative Social Environment Attractive vs Unattractive Physical Environment
Table 1: Summary Characteristics of Included Studies Reference [CASP Rating] Research Aims Country/Ethnicity Participants Data Collection Data Analysis Annear et al. (2009) [High] To explore leisure time physical activity differences among older adults from diverse neighbourhoods. New Zealand N=63 65-91 years F= 40 M= 23 Semi-structured interviews Inductive thematic analysis Aronson & Oman (2004) [Low] To explore contextual factors related to physical activity among senior citizens living in rural communities. U.S. (Oklahoma) N=26 Aged unspecified (author confirmed all participants were 65 years and above) Focus groups Thematic analysis Ceria-Ulep et al. (2011) [Medium] To describe the health beliefs regarding exercise of Filipino older adults 65 years old and above. U.S. (Hawaii)/ Filipino N=47 65-87 years F= 29 M= 18 Questionnaire and Interview Thematic analysis Chastin et al. (2014) [Medium] To explore the determinants of sedentary behaviour and motivations to reduce sitting time in older adults. U.K. (Scotland) N=9 (all female) 70-92 years Semi-structured Interviews Framework analysis Dye & Wilcox (2006) [High] To examine the perceptions regarding physical activity in low income, rural women aged over 65. U.S. (Southern state) N=28 (all female)* Focus groups Analysis unspecified Graham & Connelly (2013) [High] To understand rural older adults’ shared values, beliefs, and behaviours related to exercise as self-care. Canada (Ottawa) N=17 65-92 years F=9 M=8 Participant observation and interviews ethnography Jancey et al. (2009) [Low] To investigate the physical activity perceptions of 65–74 year olds, along with associated barriers and motivators, as well as past Australia (Perth) N=16 65-74 years Semi-structured interviews ‘Descriptive qualitative methodology’
experience and desire for future participation. F=11 M=5 Janssen & Stube (2014) [High] To explore older adults’ perceptions about participation in PA. U.S. (North Dakota) N=15 65-81+ years F=8 M=6 Interviews and participant observation Phenomenological qualitative methodology Kalavar et al. (2004) [Medium] To investigate the barriers to physical activity participation in sedentary older Asian Indians living in the U.S. U.S. (New Jersey)/ Asian Indians N=10 66-79 years F=5 M=5 Focus groups Inductive thematic analysis Leavy & Åberg, (2010) [High] To explore and describe the perceptions of physical activity held by older urban Swedish and Irish adults. Republic of Ireland (Dublin) & Sweden (Stockholm) N=30 (15 Swedish, 15 Irish) 65 -89 years F=16 M=14 Semi-structured interviews Thematic framework analysis Notes: CASP Rating: Lower scores indicate lower quality studies; Low = 3 or less; Medium = 4-6; High = 7 or more; PA=physical activity; F=female, M=male; *Dye and Wilcox: Despite stating that only women aged over 65 were invited to attend focus groups, one participant was stated to be aged 55-59 years in the results.