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Does gender influence physical activity and psychosocial factors in older exercisers? A pilot study.

How does gender influence physical and psychosocial characteristics in physically active older adults? Much of the previous research on physical function in older women focuses on either the frailty of older women or on physical function irrespective of gender. These studies leave unknown the specific influence of regular physical activity on older women.

Furthermore, few studies have examined the relationship between physical activity and psychosocial characteristics in older exercisers. We wanted to investigate whether differences exist between groups of older female and male adults who maintain a physically active lifestyle. Twenty-three female and 14 male physically active older adults performed physical function tests (i.e., chair stands, timed up-and-go, 6-minute walk) and filled out questionnaires related to psychosocial measures (i.e., social support, self-esteem, satisfaction with life). There were no differences in any physical function between the groups, and only one psychosocial measure (guidance) statistically differed (F (1, 31) = 4.14, p = .044). These results suggest that physically active women may not necessarily follow the trajectory towards frailty. More research needs to be done with a greater range of ages and physical activity levels.

As U.S. population ages, certain issues become more pressing on both an individual and a societal level. For example, older adults (over the age of 65 years of age) tend to have more health-related problems than younger adults, which results in an increase in health-related expenses (Federal Interagency Forum on Aging-Related Statistics [FIFARS], 2010). These health-related expenses disproportionately affect women. Although females have a longer life expectancy, they also have a tendency to become more frail and have more health issues later in life (Salganicoff, Cubanski, Ranji, & Newman, 2009). Physical activity offers benefits for men and women alike. Exercise is associated with positive physical and psychological health (Blair et al., 1995; Eyler et al., 1997; Gregg et al., 2003; McAuley & Rudolph, 1995; Weuve et al., 2004) and can help deter or delay the occurrence of multiple physiological-disease processes that become more common with age.

Although physical activity leads to improved physiological and psychological health, the number of older adults (65 years of age and older) who regularly engage in physical activity remains low at 22 percent. Older women are at a lower participation rate (18%) compared to their male counterparts (27%; FIFARS, 2010). Furthermore, few older women seem to adhere to exercise programs (<50%), with a high percentage dropping out after six months (Dishman, 1982; Dishman & Sallis, 1994). Why do some women adhere while others do not? Research suggests that psychosocial factors may play a large role in older adults' adherence to physical activity or sport. In fact, social support, self-efficacy, self-esteem, and quality of life have been associated with exercise participation in older adults of both genders (Fisher, Li, Michael & Cleveland, 2004; McAuley et al., 2000; Oka, King, & Young, 1995; Rejeski & Mihalko, 2001).

Much of what is known about physical activity, aging, and women comes from literature investigating cohorts born before the baby boom generation (between 1910-1930). For many of these older adults, a gym membership was unheard of, and they exercised primarily to enhance their domestic chores (Vertinsky, 1994). Furthermore, most of these older women were not exposed to physical activity or exercise during their lifespan. Over the past century, the prevailing attitudes toward women's participation in physical activity have changed dramatically. At the turn of the 20th century, women were advised against vigorous exercise, with physicians positing that physical activity might damage female reproductive systems. Moderate physical activity and 'gentle games' were encouraged to promote enough strength to perform daily tasks such as domestic chores (Vertinsky, 1994). This attitude of 'moderation' prevailed through the first half of the 20th century, even as the numbers of women participating in recreational sport increased. World War II (among other societal events) changed the popular opinion of women participating in vigorous activities, with the war campaign asking women to step in and perform hard manual labor while their men were overseas. Because of this, "baby boomer" women have very different attitudes and expectations about physical activity and health compared to previous generations.

Baby boomers are reaching an age at which they are becoming more concerned about their health and are more physically active. This is quite evident when examining the growth in participation in the National Senior Games (for those 55 and over). In 1987, 2,500 people participated in the first games compared to over 12,000 older adults in 2007 (www.nsga.org). Similarly, there has been a growth in the number of people participating in community-based programs targeting older adults. For example, there are over 600,000 men and women enrolled in Silver Sneakers, a nationwide health, exercise, and wellness program. These numbers demonstrate that the current older adult population does value the importance of physical activity and exercise participation. Furthermore, in examining gender differences with respect to participation, it is evident that women who participated in intercollegiate athletics in 1960s and 70s have remained active throughout their life (Strawbridge 2001).

In addition to previous exercise experiences, gender differences in physical activity characteristics vary with respect to other factors (e.g., obesity, frailty, living situations, diseases) that may affect physical function in older adults. Large-scale studies have found that older women are less active than men (FIFARS, 2010), while others have found few physical activity differences between men and women (Booth, 2000). Investigating one measure of physical function, the timed up-and-go (TUG), in community-dwelling older adults, Riebe and colleagues (2009) found no gender difference. However, they reported a gender--BMI interaction. Gender differences only appeared as weight increased; within the obese population, women had a significantly poorer performance on the TUG (Riebe et al., 2009.

Another study examined the influence of age and gender on physical function tests in community-dwelling older adults (Wang, Olson, Yeh, & Sheu, 2008). The findings revealed gender differences with respect to the testing measures of mobility, showing that men outperformed women in many of the measures. Several studies have focused on the loss of function in older women. Within the literature, loss of physical function has been correlated with sedentary lifestyles, which may account for a loss of strength and balance (Hillsdon, Brunner, Guralnik, & Marmot, 2005; Walston & Fried, 1999). For example, Gobbens and colleagues (2010) assessed frailty in a sample of older men and women (mean age 80 years) and found that unhealthy lifestyles (including sedentary activity) and being a woman predicted frailty. These studies are descriptive in nature, and do not generally manipulate activity levels.

Psychosocial Characteristics of Older Adults

Self-esteem, life satisfaction, and social support are considered important characteristics for exercise and physical activity adherence (Dishman & Sallis, 1994). Social support is an active and cost-effective approach to increase physical activity, and can be provided at an individual level by family, friends, or others who offer encouragement to strengthen an individual's motives to be physically active. Self-esteem is often linked to positive psychological health and can impact a person's overall life satisfaction.

The literature appears to be mixed when examining gender differences in psychosocial determinants of physical activity. In a study of older men and women, Lee (2005) found that the older women appeared to be less active and have lower self-efficacy. Investigating older adults' perception of their self-esteem seems to reveal no gender differences in their perceptions (Franzoi & Koehler, 1998; Kling, Hyde, Shovers, & Buswell, 1999; Wilcox, Bopp, Oberrecht, Kammermann, & McElmurray, 2003). It does appear, however, that perceived health may moderate this relationship in that those who perceived themselves as having poor health have lower self-esteem or more negative perceptions of their body regardless of gender (Whitbourne, Sneed & Skultety, 2002).

Social support differences between older men and women also appear to play a role in physical activity participation (Chipperfield, Newall, Chuchmach, Swift, & Hayes, 2008; Hawkley, Thisted, & Cacioppo, 2009; Klumb & Bakes, 1999). Loneliness in general appeared to be a risk factor for both men and women in terms of physical inactivity (Hawkley, Thisted, & Cacioppo, 2009). In a cross-sectional study of older men and women, living arrangements seemed to affect women more than men (Chipperfield et al., 2008). Women living alone had lower levels of activity and desired to have someone to help them become motivated to exercise. It is possible that women have higher perceptions of barriers and that men are more motivated to participate in organized sport programs compared to women (Ashford, Biddle, & Goudas, 1993).

The purpose of this research was to examine several gender differences in the physical and psychosocial characteristics of physically active older adults. We hypothesize that, although physical gender differences disproportionately disfavor females in a sedentary population, active older adults of both genders will have similar physical characteristics. In addition, we hypothesize that exercisers of both genders will show similar, high levels of self-esteem, social support, self-efficacy, and quality of life.

Method

Overview

In the current study, physical and psychosocial characteristics of male and female older adults who engage in different forms of physical activity' were compared using a battery of fitness tests and psychosocial assessments. Participants were tested at one of two sites with the same testing personnel conducting the fitness tests. The order in which participants completed each data-collection session was standardized. Surveys were completed prior to any physical testing. All procedures were approved by the institution's review board. All participants signed an informed consent form before participating, and were provided with a small monetary reward after completing data collection.

Participants

A total of 37 older adults participated in this study (23 females, mean age = 65.9 [+ or -] 4.3; 14 males, mean age = 66.9 + 5.2). Participants were recruited from local walking groups and sport teams from the area in and around northern Delaware. The inclusion criteria were: (1) participating in physical activity (e.g., volleyball, basketball, softball, walking); (2) participating on a regular basis, at least 2 times per week; (3) currently between the ages of 60 and 75 years old; and (4) having no current health problems that would limit them from functional testing. Table 1 includes demographic and anthropometric information about participants.
Table 1 Demographic and Anthropometric Measures of Study
Participants

Measure Male Female

Age (years) 66.9 [+ or -] 5.2 65.9 [+ or -] 4.3

Height (cm) 177.1 [+ or -] 5.49 163.2 [+ or -] 5.1

Body Mass (kg) 73.1 [+ or -] 6.9 73.1 [+ or -] 6.9

BMI 25.5 [+ or -] 4.2 25.6 [+ or -] 3.5

Godin Score 34.1 [+ or -] 14.1 42.4 [+ or -] 23.8


Procedures

Testing occurred at either the University of Delaware Human Performance Laboratory or at the Lewes Senior Center in Lewes, DE. The same personnel tested at each site and the same equipment was used. When participants entered the laboratory, they were first asked to complete a survey related to physical activity levels. Physical function was measured via a series of tests from the Senior Fitness Test Manual (Rikli & Jones, 2001). Once participants finished testing, they received $25.00 for their participation.

Physical Measures

Physical Activity. The Godin Leisure-Time Exercise Questionnaire (Godin & Shephard, 1985) was used to assess exercise behavior. The questionnaire consists of a 4-item scale on which individuals indicate their participation in strenuous, moderate, and mild exercise, as well as the frequency of activity at a level that results in sweating. An overall activity score was calculated. Reliabilities for the scale range from 0.48 to 0.94, which are considered good for this type of questionnaire (Godin & Shephard, 1985).

Timed Up-and-Go. This test is considered to be a good measure of several fitness indices, including balance, speed, agility, and power (Podsiadlo & Richardson, 1991; Tinetti, 1986). Participants sat in a sturdy chair with their hands on their lap. Upon receiving a start command, they stood up, walked around a cone that was placed on the ground eight feet away, returned to the chair, and sat down. Participants were not permitted to use their hands for support or to run around the cone. Two trials were given and the shortest time required to complete the task was recorded.

Chair Stands. This is a measure of lower-body strength and has been deemed reliable (.77) compared to a 1 RM leg press (Jones, Rikli, & Beam, 1999). Participants sat in a sturdy chair with their arms across their chest. They were instructed to stand up and sit down as many times as possible in 30 seconds. Subjects were notified when 20 seconds remained and again when 10 seconds remained. The number of full repetitions completed was recorded.

Six-Minute Walk. As a measure of aerobic endurance, participants were asked to walk continuously at a quick pace that they could comfortably maintain for some time. To control for temperature, all subjects walked indoors. Due to space limitations, participants were required to walk around two cones set apart from each other in a long hallway. The distance between the cones was measured before each data-collection session. It was then multiplied by the number of repetitions completed by each participant to yield a value of distance covered (in km) in the six minutes allotted.

Psychosocial Measures

Social Support. The Social Provisions Scale (Cutrona & Russell, 1987). This scale assesses 6 different provisions of social support: guidance, reassurance of worth, attachment, opportunity for nurturance, reliable alliance, and social integration. Participants were asked to rate on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree) their responses to 24 statements about others in their social network. The scale was modified to specify individuals in their exercise group. Statements included, "Other people in my exercise social network frequently turn to me for help," "There is someone in my exercise social support network to whom I feel very close," and "There are people in my exercise social support network who believe in my abilities." Scores were based on the sum of the items for each subscale and the total score was based on the sum of all items. Reliabilities for each subscale and overall scale are good (0.65-0.76).

Satisfaction with Life. The Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) was used to assess participants' quality of life. This is a 5-item scale in which participants respond to questions about their past, present, and future satisfaction with their life. This scale is a global measure of subjective well-being. Respondents were asked to rate how much they agreed with the five statements using a 7-point scale where 1 = strongly disagree, 4 = neither agree nor disagree, and 7 = strongly agree. Statements include, "In most ways, my life is close to ideal," "If I could live my life over, I would change almost nothing," and "I am satisfied with my life." It has been validated in several population studies and shows good convergent and discriminate validity relative to other subjective well-being scales (Pavot & Diener, 1993). A composite score was calculated by summing the items. Reliability analysis yielded an acceptable Chronbach's alpha score of .89.

Self-Esteem. Self-esteem was assessed via Fox and Corbin's (1989) Physical Self-Perception Profile. This is a 24-item questionnaire in which the participants rate their responses to statements about themselves on a 4-point Likert scale (1 = not true at all, 2 = somewhat untrue, 3 = somewhat true, 4 = completely true). Statements include, "I am extremely proud of who I am and what I can do physically," "I feel confident in the physical side of myself," and "I wish that I could have more respect for my physical self." Four subscales (physical condition, body attractiveness, strength esteem, and physical self-esteem) along with an overall score of physical self-esteem were calculated.

Statistical Analyses. Male and female groups were compared on dependent measures using a 1-way ANOVA for physical function characteristics and for psychological characteristics. Alpha was set at .05.

Results

Physical Activity Profiles. Within the group of older women, 62% exercised 5 to 7 days per week in at least one primary activity, and of this group, 33% exercised an additional 3 to 4 days a week in a secondary activity. Thirty-three percent of this group exercised 3 to 4 days per week, and the remaining 5% were active 1 to 2 days each week. The primary form of physical activity was walking, in which 83% of the sample participated. Other activities included volleyball, gardening, bicycling, water aerobics, swimming, tennis, basketball, softball, running, resistance training, yoga, windsurfing, badminton, and golf. Within the group of older men, 50% were physically active 5 to 7 days a week in a primary activity, with 29% of these individuals active 3 to 4 days a week in an additional activity. Of the remaining participants, 29% were physically active 3 to 4 days a week, and 21 % were physically active 1 to 2 days per week. Physical activities were the same as those chosen by the female group, with the exception of aerobics which was an activity for the females.

Physical Measures. The female and male groups did not perform very differently on the chair stands (15.6 [+ or -] 3.6 vs. 16.4 [+ or -] 4.4 in 30 sec., p = .601), timed up-and-go (4.4 [+ or -] .53 vs. 4.6 [+ or -] .70 sec., p = 2.75), 6-minute walk (.664 [+ or -] 72 vs. .672 [+ or -] 71 km, p = .266), or Godin scores (42.4 [+ or -] 23.8 vs. 34.1 [+ or -] 14.1, p = 2.44). Figure A provides the means and standard deviations of the two groups.

[FIGURE A OMITTED]

Psychosocial Measures. The two groups differed significantly on only one measure, that of Guidance (F (1, 31) = 4.14, p = .044). No other measures were statistically different (see Figure B).

[FIGURE B OMITTED]

Discussion

Previous research has suggested two different notions about physical activity in the aging population. First, older women who are not physically active have a propensity to be more frail than their male counterparts (Gobbens et al., 2010). Second, physically active older adults have better physical function (Hillsdon et al., 2005). Furthermore, those who maintain a physically active lifestyle have associated higher levels of psychosocial measures, such as satisfaction with life and self-esteem (Steriani, 2009; Vance, Wadley, Ball, Roenker, Rizzo, 2005). 'What has yet to be determined is whether these physical activity benefits differ between the genders; that is, will physically active females differ from males in their physical and psychosocial characteristics? We have started to sort out the influence of gender on physical and psychosocial measures in active older adults with the current research. Perhaps the most important finding is that within our sample of physically active older adults, we found that both males and females scored similarly on measures of physical function. In addition, the only psychosocial characteristic in which groups differed was Guidance, where females had higher values than males.

Although this research is preliminary, the results suggest that gender differences found in previous research may be less a function of gender and more related to levels of physical activity in the participant sample. As previously mentioned, much of the research conducted that shows gender differences has focused on older women who grew up in the pre--World War II era, when strenuous physical activity was neither promoted nor socially acceptable (Cahn, 1994). Women tend to live longer; therefore, there is a greater proportion of females in the elderly population. The frailty often exhibited by this population may not, however, be explained by gender, but rather by a complex combination of age, social expectations, and lowered physical activity levels across the life span. We suggest this based on the lack of gender differences found in this study, which shows that physical activity may help slow the progression towards frailty in both genders. Although this seems almost common sense, there has been almost no research performed that specifically examines gender differences and physical function in an aging population. Our results are based on a small sample, but we believe they warrant replication in a larger group of older adults.

The Godin score, although not showing statistical differences, did show that females reported higher levels of activity on average. The Godin score provides a self-reported measure of exercise intensity and frequency. Although only conjecture at this point, one might think that higher levels of physical activity among the females in our sample may contribute to the similarity in physical function scores between the two groups. With greater statistical power, differences may have emerged in this measure; future studies should not only include a larger number of participants, but also stratify the sample on Godin score to observe how different levels of exercise affect physical and psychosocial function.

In a comparison to previously published data (McAuley et al., 2005) where those participants were initially sedentary or minimally active, our study population has higher levels of self-efficacy, self-esteem, and social support. This supports the notion that physical and psychosocial functions vary together. We know from social cognitive theory that there is reciprocal determinism between personal factors (self-esteem, self-efficacy), environment (physical or social), and behavior (physical activity). With this design, we cannot say that increased physical activity drives higher levels of these psychosocial measures or vice-versa. However, we believe that this supports to the notion that physical activity has a broad range of benefits for older adults.

The lone exception in terms of gender differences was Guidance. The higher level of the social provision of guidance among women refers to the notion that they may desire to have someone as a leader or authority figure in an exercise group. This may indicate that women may benefit from participating in a team or group approach with one or more authority figures. The benefit may include adherence to exercise and increased physical activity participation. Previous studies have found that social support, specifically guidance, has been related to exercise adherence in adults participating in structured exercise programs (Duncan, McAuley, Stoolmiller, & Duncan, 1993; Oman & Duncan, 1995). Additional evidence points to guidance being an important factor in women's adherence to an activity (Duncan, Duncan, & McAuley, 1993). It may be, as Cross and Madson (1997) suggested, that women view guided physical activity as an opportunity to socialize with others, while men value independence when considering social support and the concept of guidance. Therefore, the importance of relationships related to exercise participation may lead women to be more successful in a team or group cohesion approach.

A team approach involves planning activities within a group setting where individuals within the group establish goals together and provide supporting to one another (Carron & Spink, 1993). This differs slightly from a group activity such as aerobics, where many people do the same activity, but do not interact and do not work together toward a common goal. The advantage of a team approach for older adults is that higher levels of social support may improve adherence. Fraser and Spink (2002) found that social support in the form of guidance was an important factor in group cohesion when examining exercise compliance.

The research suggests that the team approach has been successful for older adult populations in exercise interventions (Brawley, Rejeski, & Lutes, 2000; Estabrooks & Carron, 1999). Estabrooks and Carron had adults set a common goal of logging miles to walk across the Province of Ontario and then work together to meet their goal. The team- or group-mediated approach was also successful in adherence to an exercise intervention in a group of people 65 and older (Brawley et al., 2000). It is possible that the social interaction and communication in these interventions play a key role in the physical activity levels of older adults. Given that women scored higher on guidance, providing a coach or team leader may motivate these women to exercise more.

We hope this research will spur others to more closely examine gender differences both between genders and across the spectrum of physical activity participation. Limitations of the current study include the sample size and non-equal gender groups. Because this was a cross-sectional study, the development of a team concept and changes in physical parameters and psychosocial parameters could not be studied over time. Future research should also include long-term interventions designed to increase physical activity levels in frail older adults of both genders.

Acknowledgments

This research was funded by a General University Research foundation grant from the University of Delaware. We would like to thank all of the participants who were involved in this research for maintaining such enthusiasm about physical activity and aging.

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Elizabeth Orsega-Smith, University of Delaware Nancy Getchell, University of Delaware Lindsay Palkovitz, University of Delaware

CONTACT INFORMATION:

Elizabeth Orsega-Smith Department of Behavioral Health and Nutrition 9 Carpenter Sports Building University of Delaware Newark, DE 19716

E--mail: eosmith@udel.edu

Phone: (302) 831-6681

Fax: (302) 831-4261
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Title Annotation:Original Research Article
Author:Orsega-Smith, Elizabeth; Getchell, Nancy; Palkovitz, Lindsay
Publication:Women in Sport & Physical Activity Journal
Article Type:Report
Geographic Code:1USA
Date:Mar 22, 2012
Words:5487
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