1. Could the transition to retirement be an opportunity for physical activity promotion? Inka Barnett, Conny Guell, David Ogilvie 24 th January 2012 Institute of Public Health

2. Why study the transition to retirement? The population is aging Increases in chronic diseases & healthcare demands Physical activity (PA) to maintain health PA levels decrease in older age (HSE 2008) Transition to retirement as turning point in PA ‘Critical window’ to target interventions to promote and maintain PA ?

3. Aim of the systematic review To review qualitative and quantitative evidence on changes in PA across the transition to old-age retirement Quantitative evidence to examine whether PA changes across the transition to retirement Qualitative evidence to explore experiences of and views on PA around the transition to retirement

4. Three-stage method (adapted from Noyes et al. 2008) Quantitative evidence Quality assessment (CASP) Data extraction Semi-quant. synthesis (n=19) Qualitative evidence Quality assessment (CASP) Data extraction Textual narrative synthesis (n=5) What is known about changes in PA across the transition to retirement ? Parallel synthesis approach (qualitative evidence to explain & interpret quantitative evidence)

5. Methodology Search of 19 databases Observational study designs, free-living PA Published 1 st January 1980 to August 2010 No language or country restriction Exclusion: Retired professional athletes, temporary retirees Physical capability/fitness only

6. Results 19 quantitative and 5 qualitative studies Quality rating medium to good Most studies set in USA (52%) and published after 2000 Quantitative studies: Imprecise PA assessment Qualitative studies: Focus on leisure-time PA

7. Quantitative results: Harvest plot

8. Qualitative results: Emerging sub-groups PA as provider of new routine, personal challenge, social interactions Benefits for health and well-being Retirement as a busy time Personal value of PA Broad concepts of PA

9. Parallel synthesis (I) Can the qualitative evidence explain the increase in leisure-time PA and exercise?

10. Parallel synthesis: Cross-study matrix

11. Strengths and Limitations Strengths First systematic review on changes in PA across the transition to retirement Novel way of using of parallel synthesis to combine qualitative and quantitative evidence Limitations of evidence Imprecise PA measurement Small number of qualitative studies

12. Conclusions Quantitative evidence suggests changes in PA after the transition to retirement Qualitative evidence provides a deeper understanding of the underlying motives Interventions to promote adoption & maintenance of PA in retirement need to address motives

13. Ongoing projects EPIC Norfolk analysis EPIC Europe analysis Qualitative study in Norfolk

14. ACKNOWLEDGEMENT This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

15. Thank You Questions?

16. Systematic review: Inclusion and exclusion criteria Inclusion: PA behaviours at and around the transition to retirement All domains and methods of assessing PA Old-age retirement Exclusion: Old age without the transition to retirement Pre-or post-retirement without the transition Only temporary or ill-health retired, retired professional athletes Only physical capability or fitness

17. Systematic review: Quality assessment

18. Definition of retirement ‘ The permanent withdraw from office or official position’ (Oxford Dictionary of English) Retirement is a complex phenomenon and difficult to find one definition, perhaps depending on purpose (Denton et al. 2009) Old-age retirement (exclude: retired athletes, only early retired, only ill-health retirees, only temporally retired)