Disability and physical activity in late life—research models and approaches

Abstract

Prevention of disability in late life has become a major public health concern, a key area of ageing research, and also an important target for the development of effective interventions. The increase in life expectancy and the resulting growth of the elderly population are also thought to be driving up the number of elderly people with disabilities. Despite the message that regular moderate physical activity has substantial health benefits even in very old age, older people remain largely sedentary. The most popular theoretical model for researching the development of disability is the disablement process, which is widely used, in the gerontological literature. The main pathway according to this model leads from diseases and injuries to impairments, functional limitations, and disability. This approach has been challenged most particularly by models, which emphasize the social construction and determinants of disability. Numerous physical exercise interventions have aimed at preventing impairments, functional limitations and disability, and at promoting independent living in late life. A review of the results of these interventions shows that exercise can indeed be effective in preventing impairments and functional limitations, but the evidence regarding the prevention of disability and dependency is inconclusive. The inconsistency of the results is related to differences in research models and approaches, cultural and other differences between the populations studied, and variability in research designs and methods, including definitions of key variables. In the future, research-addressing disability in late life needs to focus on the dynamic interactions between individuals and their social, physical, and cultural environment. Furthermore, randomized trials that are larger and longer than most existing studies of physical activity need to be conducted. Additional evidence can also be obtained by well-conducted observational studies focusing on the prevention of progressive disability related to chronic conditions. One of the key areas of development is in improving the definition of both independent (physical activity and exercise) and outcome (functional limitations, disability) variables. A further challenge is presented by the investigation of dose-response relationships, including both beneficial and possible adverse effects of exercise.

Physical functioning: The mediating effect on ADLs and vitality in elderly living in residential care facilities. “Act on ageing”: A pilot study

“…Understanding the processes underlying the effects of physical activity on the sense of psychophysical wellbeing in the oldest elderly can help promote active ageing by also meeting the needs of institutionalised older people, who see independence in daily life as a crucial factor [42] but who also wish to participate in activities that are rich in meaning [43,18].…”

“…[16] showed that an increase in physical activity is related to an enhanced sense of self-efficacy, which in its turn is associated with an increase in physical performance. Keysor [17] and Heikkinen [18] found that self-efficacy is a mediator in the relationship between physical activity and functional limitations. From what we know, other psychological characteristics apart from self-efficacy were hardly ever considered.…”

Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature

“…age in healthy individuals [22]. Any additional factor including musculoskeletal pain which negatively impacts on the physical activity level of this group may have adverse consequences for overall health.…”

A life course approach: research orientations and future challenges

“…Furthermore, individuals have different abilities for adaptation in the changing situations, and they differ in the capability to select among different activities, optimize resources, and to use compensatory means so as to be able to carry out the most important activities [34]. When age-related decline in repertoire (health and functioning) threatens the individual's capability to attain important goals, it is possible to improve the disturbed balance between repertoire, personal goals, and environment by e.g., rehabilitating functioning, changing goals, and improving the social and physical environment [35].…”