1. Applying an Ecological Perspective to Physical Activity Participation in Older Adults
Talina S.M. Corvus, PT, DPT, LMT, CEEAA
Pacific University
Interprofessional Education and Leadership Conference 2018

2. PURPOSE
As the aging population in the United States is expected to grow to nearly 24% of the total population by 2060, the costs related to treating chronic illness and disability in older adults are also expected to rise (Mather, 2016). Remaining physically active as we age contributes not only to decreased disability but also to decreased risk for many chronic diseases (CDC,1999). Currently, 21% of adults meet the guidelines for recommended physical activity (CDC, 2014). Determining how to successfully promote sustained physical activity (PA) in older adults, however, has been a challenge explored by several fields of study. Often these explorations look to determine which factors, including; environment, health literacy, self-efficacy, race and socioeconomic status, play the most significant roles in promoting or setting up barriers to PA participation. Physical Therapists, who are uniquely positioned to advocate for PA in the general population (Verhagen, 2009) are already accustomed to evaluating the direct role of the environment and self- efficacy when prescribing exercise, but do not have parameters in place to objectively examine the roles played by health literacy, past experience, race and culture, socioeconomic reality, or the indirect roles of self-efficacy, which include expectations of outcomes, goal setting, and social facilitators and impediments to performance (McAuley, 2009) in successful PA engagement. The goal of this research inquiry is to examine perspectives on how life experience, life course, and indirect elements of self-efficacy influence physical activity participation in current literature with the aim of informing research design geared towards a potential dissertation topic.

3. METHODS
Methods undertaken to perform a review of the literature involved searches of online research databases, including Google Scholar, American Physical Therapy Association, Health Promotion Research Center, Active Living Research, and the World Health Organization. Examining the authors and articles citing relevant publications was also used to track additional relevant works, as well as the direction of follow-up research in the field. Search terms used included: aging, mobility, physical activity, older adults, community, physical therapy/therapist, health, and wellness.

4. SUMMARY OF LITERATURE REVIEW
A list of themes and publications that were key in providing insight and guiding future inquiry are provided, along with a brief explanation of salient points.

5. SUMMARY OF LITERATURE REVIEW CONTINUED
The need to pair cognitive or behavioral interventions with physical or activity interventions in order to achieve a meaningful impact was a frequently demonstrated in the literature. The concept of evaluating a person and their needs with attention to the full ecology of their life is introduced. King et al. (2000) began looking into aspects of the life and environment that change activity participation, including the participants potential obligations as a caregiver, and the level of energy these obligations can take from PA motivation. King begins to demonstrate correlations between barriers and promoters of PA and degrees of participation at all ecological levels. Publications by King (2001) and Chase (2013) introduce and then reinforce the observations that PA interventions achieve stronger and longer effects when the factors personal to the individual experience and environment are addressed in addition to direct PA recommendations. McAuley et al. (2009) makes a case for the potential folly of providing the same intervention to improve PA in sedentary women as in women who have a history of participating in PA, as personal factors may differ.

6. SUMMARY OF LITERATURE REVIEW CONTINUED
The idea that prior life experience with PA may influence participation later in life is also brought up in isolation. Barnett et al. (2012) found that higher participation in PA for recreational purposes was seen in adults who had a history of lifelong PA engagement. Job McIntosh (2016) provides a study that looks at the prevalence of female athletes remaining active in recreational sport, having been involved sport performance, as they age and the psychological factors that contribute to them building and maintaining an identity around being active through transitions that occur later in life.

7. SUMMARY OF LITERATURE REVIEW CONTINUED
Life transitions, particularly the transition to retirement is another theme that is being explored in the literature. Barnett et al. (2012) continues to explore PA later in life and touches on the opportunities that retirement provides, including more available time, inspiration to seek social stimulation, and the seeking out of a new routine. Kosteli et al. (2016) raises the argument that in order to understand a person’s relationship to PA after retirement we must first understand what retirement means to that person. Baxter et al. (2016) found that there are currently a variety of interventions to increase PA in older adults that show some effectiveness but no clear indication that intervening during this transitional time is more or less effective in achieving long term outcomes.

8. SUMMARY OF LITERATURE REVIEW CONTINUED
Many of the articles singled out for relevance highlighted areas of research that warrant additional inquiry. Based on the barriers to PA imbedded in personal and environmental variables, Prohaska (2006) singles out the need to apply an ecological approach to PA assessment, implementation, and evaluation in older adults. This study also suggests that there is value in research to understand social and environmental contexts that promote PA in a way that is inclusive, along with research into how best to evaluate the adaptation or success of an intervention program in a community.

9. OBSERVATIONS FROM LITERATURE REVIEW
The further exploration and inclusion of social ecological models, defined as the interaction of the person and the environment, to describe and intervene in the variables that influence physical activity participation in older adults will be key in making program design and implementation successful. For this to occur, our understanding of self-efficacy, one’s belief in their ability to succeed, should be broadened so as to reduce the compounding of intersecting factors. The study by Prohaska (2006) states that, “health and well-being are affected by a dynamic interaction of biological, behavioral, social, environmental, and policy factors, an interaction that unfolds over the life course of individuals, families, and communities”. Studies did not demonstrate a strong correlation between reported self-efficacy and PA engagement. Equally of interest was the lack of consistent findings on the role of demographic variables alone in predicting PA participation; correlations between geographical resources, race, and education level were observed, but so too was an absence of correlation between demographics and decline in PA.

10. OBSERVATIONS FROM LITERATURE REVIEW
Currently, as self-efficacy and demographics are used to explain PA behaviors, opportunities for more meaningful and effective interventions may be being overlooked. Physical Therapists are uniquely positioned to provide nuanced education and interventions, as they are allotted one on one time and trained to use various physical and psychological evaluative tools, however, training in the recognition and integration of social intersections into PA program design is not standardized in provider education. In seeking education and design elements in the research that incorporate concepts of ecological models, there were examples of potential benefits to mentorship, target population involvement in program design, goal setting, and positive feedback in achieving better outcomes. Each of these examples, however, lacks sufficient data, at present, to understand if, how, and why they could be used successfully in a variety of regions and populations. This field may be served by research designed to explore what elements make a PA intervention that includes both cognitive and behavioral aspects successful.

11. PROPOSED INQUIRIES BASED ON REVIEW FINDINGS
Does past performance experience contribute to levels of self-efficacy around PA in older adults?
Does level of self-efficacy alter PA goal setting in older adults?
What social and environmental factors contribute to PA promotion in older general and under-represented populations?
What is the rate of success of community PA programs aimed at older adults, and how is success measured?
How does target community participation in PA program design impact program participation, satisfaction, and measures of success?
Does positioning older adult mentors as leaders in a PA community increase PA levels in peers?
Do PA interventions, including ecologically informed education, at the time of transition from working to retirement increase PA levels in older adults?
Can teaching health professional students to conduct patient evaluation, education, and instruction in PA with the inclusion of ecological models increase patient adherence and outcomes?

12. PRELIMINARY RESEARCH QUESTION EXPLORATION
How does target community participation in PA program design impact program participation, satisfaction, and measures of success among older adults?
Appealing Aspects of the Question
Allows for the address of under-represented populations in research design
Creates an opportunity for community-based participatory research
Allows for the exploration of the role of social ecological models in PA program design
Creates an opportunity to explore the function of community based leadership
Potentially creates an opportunity to involve healthcare students in community education opportunities

13. PRELIMINARY RESEARCH QUESTION EXPLORATION
How does target community participation in PA program design impact program participation, satisfaction, and measures of success among older adults?
Desired Outcomes of the Inquiry
Increased understanding of the role of community input in creating and implementing programs to increase physical activity levels in older adults
Provide insight into the strengths and weaknesses of community based leaders in promoting physical activity among older adults
Gain insights around how best to prepare health professions students to be successful advocates for physical activity participation in their communities

14. REFERENCES
Barnett, I., Guell, C.,&Ogilvie, D. (2012). The experience of physical activity and the transition to retirement: A systematic review and integrative synthesis of qualitative and quantitative evidence. The International Journal of Behavioral Nutrition and Physical Activity, 9(1), doi: /
Baxter, S., Johnson, M., Payne, N., Buckley-Woods, H., Blank, L., Hock, E., Goyder, E. (2016). Promoting and maintaining physical activity in the transition to retirement: A systematic review of interventions for adults around retirement age. The International Journal of Behavioral Nutrition and Physical Activity, 13, 12. doi: /s
Center for Disease Control and Prevention. (1999). Physical Activity and Health: A Report of the Surgeon General, Older Adults. Retrieved from
Center for Disease Control and Prevention. (2014). Facts About Physical Activity. Retrieved from
Chase, J. D. (2013). Physical activity interventions among older adults: A literature review. Research and Theory for Nursing Practice, 27(1), doi: /
Job McIntosh, C. (2016). Aging female athletes: The challenges of performance, policy and the pursuit of health (Doctoral Dissertation). Retrieved from University of Calgary Libraries and Cultural Resources. ( T23:10:47Z)

15. REFERENCES
King, A. C. (2001). Interventions to promote physical activity by older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56 Spec No 2(Supplement 2), doi: /gerona/56.suppl_2.36
King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F.,&Brownson, R. C. (2000). Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychology, 19(4), doi: //
Kosteli, M., Williams, S. E.,&Cumming, J. (2016). Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach. Psychology&Health, 31(6), doi: /
Mather, M. (2016). Fact Sheet: Aging in the United States. Retrieved from Population Reference Bureau
McAuley, E., Hall, K. S., Motl, R. W., White, S. M., Wójcicki, T. R., Hu, L.,&Doerksen, S. E. (2009). Trajectory of declines in physical activity in community-dwelling older women: Social cognitive influences. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64B(5), doi: /geronb/gbp049
Prohaska, T., Belansky, E., Belza, B., Buchner, D., Marshall, V., McTigue, K., Wilcox, S. (2006). Physical activity, public health, and aging: Critical issues and research priorities. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61(5), 267. doi: /geronb/61.5.S267

16. REFERENCES
Thornton, C., Kerr, J., Conway, T., Saelens, B., Sallis, J., Ahn, D., King, A. (2017). Physical activity in older adults: An ecological approach. Annals of Behavioral Medicine, 51(2), doi: /s
Verhagen, E A L M,&Engbers, L. H. (2009). The physical therapist's role in physical activity promotion. British Journal of Sports Medicine, 43(2), doi: /bjsm

17. AUTHOR CONTACT INFORMATION
Talina S. M. Corvus, PT, DPT, LMT, CEEAA Pacific University PhD in Education and Leadership Program 2043 College Way Forest Grove, OR School of Physical Therapy and Athletic Training 222 SE 8th Ave, rm 357 Hillsboro, OR 97123