Increasing physical activity is a goal of
Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7–13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD ± 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis.
Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety.
Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.
Because of the known health benefits of physical activity, increasing physical activity is a goal of
Ethnic minority communities in the United States experience a high prevalence of chronic diseases that may be prevented or ameliorated by physical activity. African Americans, Latinos, American Indians, and Filipinos have a higher incidence than whites of diabetes, hypertension, stroke and overall mortality (
Despite the known benefits of physical activity and the health needs of ethnic minorities, information is limited on factors that encourage older, ethnic minority adults to be physically active (
To better understand the needs and desires for physical activity programs among older, ethnic minority adults, we conducted focus groups with older adults from seven cultural groups, including five groups of older immigrants. The purposes of the study were to 1) identify barriers and facilitators to engaging in physical activity and 2) broaden our understanding of culturally appropriate physical activity and exercise programs.
Focus groups were conducted with older adults to explore the motivations and barriers of physical activity within each of seven cultural/linguistic groups: American Indian and Native Alaskan, African American, Vietnamese, Cantonese-speaking Chinese immigrants from Vietnam, Korean, Tagalog-speaking immigrants from the Philippines, and Spanish-speaking immigrants primarily from Mexico, and also from El Salvador, Columbia, Nicaragua, Peru, and Equador. The focus groups were conducted in the primary languages of the participants. Participants were recruited from local community agencies and represented large minority communities in the Seattle area, as well as groups that have been typically underserved by existing programs promoting physical activity. Recruitment took place in October 2002, and focus groups were conducted during November 2002 through February 2003.
Four community agencies partnered with the university-based research team. These four community partners were social and health service providers that meet the needs of the following ethnic groups: Asian Americans and Pacific Islanders, African Americans, American Indians, and Latinos. Representatives from each of the agencies met with the research team to strategize the implementation of the focus groups and to develop a discussion/interview guide. Agency representatives identified facilitators and note takers for each focus group from staff members who were culturally and linguistically competent.
Facilitators and note takers recruited participants from clients at their agency using recruitment guidelines to ensure a range of ages, varying levels of physical activity, ability to speak the language of the group, and cognitive ability for meaningful participation.
Seventy-one adults (59% women) participated in one of seven focus groups (
Facilitators used the interview guide (
Facilitators and note takers attended a one-day training session focusing on learning about the research study and the role of physical activity for older adults, in addition to developing skills to facilitate a focus group. Training was held during the day at a convenient central location. Upon approval from the University of Washington Institutional Review Board, study personnel from the partnering agencies invited older adults from their client base to attend the focus group. Focus groups were audiotaped. Although transportation was not provided, the focus groups were held in locations frequently used by the participants, such as meeting rooms of community agencies or senior center meal sites. Notes from note takers provided backup in case of recording equipment failure. Each focus group meeting lasted 60 to 90 minutes. Participants were each given a $25 honorarium.
Professional translators transcribed the audiotapes into the language of the group and then translated the transcript into English. QSR NVivo qualitative analysis software (QSR International Pty Ltd, Melbourne, Australia) was used to organize the data. Members of the research team representing several disciplines — including cultural anthropology, nursing, social work, and public administration — systematically reviewed the translated transcripts, coding them for emerging themes. The team members had expertise in aging, exercise, and community-based participatory research.
Initially, all research team members reviewed and coded one of the transcripts. The team then met to review and discuss their coding. This discussion across disciplines provided a framework to review and code the remaining transcripts. Subsequently, each team member chose one of the remaining transcripts to code, with the coding then reviewed and discussed by all of the research team members. The research team invited the facilitator and note taker from each of the groups to participate in the discussion of the transcript coding. A consensus was reached on coding each transcript.
Major themes emerged after reading and discussing the transcripts, coding reports, and summaries. A draft report of the results was sent to facilitators, note takers, and other representatives from the partner agencies. The research team convened a meeting of community partners to elicit feedback on the draft results and to enrich the interpretation of findings, including ideas for potential programming.
A common thread across groups was that exercise is one component of health promotion along with proper nutrition, caring for ones' emotional health, keeping the mind active, and socializing. Walking, both as exercise and as a mode of transportation, was the physical activity of choice across all groups. Participants frequently mentioned both health and social benefits as motivating factors for being physically active, especially as these factors related to managing chronic conditions such as diabetes, arthritis, hypertension, and pain. When physically active, participants felt stronger, healthier, and more energetic. One participant from the Tagalog group said, "Exercising and walking gives you energy. That's how you strengthen your body. Your weakness disappears when you walk a lot."
Paradoxically, both the key motivator and primary barrier for physical activity were related to health and chronic conditions. Participants cited examples of how physical activity helped them to manage chronic conditions. Chronic conditions, however, also hindered many from being physically active. Some reported not being physically active when sick or injured. Additionally, participants were aware that psychological health impacted desire and motivation to be physically active.
Children and other family members helped participants to be physically active by purchasing exercise equipment to use at home, transporting participants to programs, or providing encouragement. One African American participant said, "My son bought me a walk odometer, so I can tell how far I walk." Participants also kept active to remain healthy so they would not burden family members. One Korean participant commented, "My being sick makes my children suffer."
Environmental factors that hindered participants from being physically active or required modification of physical activity included weather; neighborhood safety; fear of crime; program costs; and inadequate availability, frequency, and reliability of affordable transportation. All groups made some reference to barriers, but some offered solutions.
A history of oppression and the resulting poverty and low self-esteem were common threads throughout the American Indian/Alaska Native (AI/AN) group. Low self-esteem was associated with lower motivation for self-care, including physical activity. In addition to walking, the AI/AN participants frequently mentioned providing care to other seniors as a common activity. The group expressed feelings of being disconnected and isolated from other AI/ANs; being out of place; not fitting in; and being uncomfortable around others who are non-Indian: "When you see people using fitness facilities, you see people who don't look like me. It would help if there were a group of elders who look like me." One participant wanted to serve as a role model and give his "children and grandchildren someone to emulate." Participants in the AI/AN group reported that living with chronic conditions, such as diabetes, had raised their awareness of the need to be active and lead a healthier lifestyle.
Participants in the AI/AN group were enthusiastic about the idea of getting together regularly to discuss their health concerns and to encourage each other to be active. They expressed a strong desire to be around people of similar background and identity. The cultural and community connection was seen as very important and as a motivator for participation.
The strongest theme from this group was that of friends encouraging each other to be regularly active. "It's nice to have a friend, because if you don't feel like going, she might say something to encourage you. Or she might be after you so much that you say, 'Oh, yeah, I'll go.' And you feel so much better afterwards. Believe me."
Participants understood the current recommendation of exercising a total of 30 minutes a day in shorter cumulative intervals: "You can walk for 30 minutes a day or go about five to 10 minutes, and then go back home, and later on do the same thing. I read this in a book."
Several participants spoke enthusiastically about determination: "Main thing, you don't get lazy and you don't give up. You gotta have determination." In addition, they mentioned that exercise becomes habit forming and self-sustaining: "Exercise gets to be a part of you."
The importance of a daily activity routine was a prominent theme within this group. Many spoke of waking in the early morning and having a routine of stretching, arm swinging, tai chi, walking, or a combination of these. Several spoke of exercising in short increments several times a day. They viewed exercise as a critical part of maintaining health for older adults, even more important than taking medication. Participants viewed physical activity as helpful for digestion, blood circulation, relaxation, maintaining friendships, avoiding medication, preventing sickness and chronic pain, living longer and happier lives, and maintaining overall good health: "The most important reason for doing exercise every day is for health. It is only with health that you can have longevity."
This group reflected a certain practicality in their responses. For example, when the weather was good, they engaged in activities such as yard work. When the weather was bad, participants spoke of indoor alternatives. Furthermore, dressing appropriately allowed participants to walk outside in the rain. However, snow was viewed as more problematic because of the fear of falling and subsequent injury. Furthermore, social obligations could interfere with an exercise routine when an unexpected visit by a friend would interrupt an exercise session.
Similar to the Chinese group, Koreans spoke of the importance of a daily physical activity routine. The health benefits of physical activity served as a motivation to be active: relieving joint pain, aiding digestion, and feeling more relaxed and happy: "We must walk after each meal. It helps digestion and keeps our joints flexible." Some thought being physically active would make pain worse, but they found that, in fact, it offered relief. Some felt that exercise cured their diseases. Participants identified feeling tired and dizzy as reasons for limiting physical activity. Health care providers told participants they should not walk because of their age or health condition. Similar to the AI/AN group, Koreans expressed feelings of isolation from other Koreans, including feelings of isolation even when surrounded by other Asian American groups. "In our apartment there are only Chinese women. There is not a single Korean."
The importance of community, laughter, and socializing emerged from this group: "All of us are happy because there's laughter, storytelling, someone wins, someone loses. When we go home, we sleep soundly because there was laughter, and we played bingo." Physical activity is part of a bigger social picture. Exercise was perceived as important to counteracting the high-fat diet in the United States, which participants believed has led to increased high blood pressure among immigrants. Similar to the Cantonese-speaking group, members of the Filipino group expressed the belief that exercise aids digestion and blood circulation: "The blood is able to circulate in the person's body so the person becomes active on that day." As with other groups, a major focus was walking. Participants also mentioned stretching, tai chi, and household chores: "Before eating, I do tai chi because it's slow. That's ideal for seniors, no sudden movements."
Many Filipino participants were involved in either paid or volunteer work, such as serving as senior companions, providing childcare, and doing janitorial work. In addition to being able to send money back to the Philippines and helping others, they described how their work kept them physically active and provided enjoyment. They cited family and work obligations, however, as factors that interfered with maintaining a physical activity routine.
The Filipino group agreed that physical activity made them strong, healthy, and energetic. As with the Koreans, the Filipinos were motivated to exercise because it stimulated their appetites. They also felt younger when they were physically active
As with other groups, the Filipinos identified feeling physically bad or having an illness as barriers to physical activity. Barriers mentioned also included vision impairment and fears of tripping or falling. Although other groups verbalized safety concerns, the Filipinos expressed dramatic fears: rape, robbery, kidnapping, or being the target of a terrorist. Some felt they did not live in safe areas or were fearful of getting lost.
Feeling out of place when physical activities predominantly involve younger people, these older adults reported that socializing with other Filipinos of similar age was important. They spoke of building a Filipino center, with the values of unity, equality (no distinction between rich and poor), and cooperation. This group also spoke of providing peer instruction for others in the community: "We could share the exercise with those who still don't know it. We would go to those who do not leave their apartments."
Because faith was an integral part of the daily activities of Spanish-speaking older adults, they brought elements of their faith to many aspects of the discussion about physical activity. One participant said, "When I wake up, the first thing that I do is to pray to God. The second, I exercise."
The primary barrier to physical activity was not having a friend with whom to engage in physical activities. Similar to the Korean group, this group also mentioned dizzy spells and lack of energy as interfering with being active. This group and the Filipino group were the only two to identify visual and hearing impairments as barriers to physical activity.
Vietnamese older adults strongly emphasized a consistent routine of daily exercise. Similar to the Cantonese and Filipino groups, participants viewed physical activity and massage as important to blood circulation. Vietnamese participants spoke of being in good health and active in spite of their age. By remaining physically active, participants said, they could avoid medication use. One participant commented, "Whether or not you are old or young, if your muscles are not stiff, you will have good health. If you are lazy and your muscles are stiff, you will become weak and you aren't able to do anything. It is a matter of daily activity and it must be consistent."
Participants in the Vietnamese group identified geographic isolation as a barrier to physical activity. Participants lived too far from friends or too far from a park or other acceptable places to walk. Similar to the Chinese group, this group had practical responses to weather-related barriers. If it rains, they expressed that they can use indoor exercise equipment, walk in an indoor shopping mall, or do housework. Participants perceived cold weather as more problematic than rain when exercising, citing that it is difficult to breathe in cold weather.
Ideal programming for physical activity and exercise for older adults from multicultural groups would be "a paradise for seniors" as stated by one Chinese participant (
Results of this study reveal that although there are ethnic-specific variations in factors influencing physical activity, there are more common themes than variations. Within an ecological model (
Knowledge of modifiable factors such as motivation and attitudes may help to develop interventions with the ultimate goal of changing behavior and influencing outcomes. Similar to our findings, Eyler et al found that lack of motivation was a common barrier to increasing physical activity (
It is interesting to note that whereas lack of health contributes to sedentary lifestyles, lack of health also serves as a motivator to become more physically active. Changes in health status, therefore, may serve as cues to adopt a healthier lifestyle. In contrast to other studies that explore barriers and enhancers to physical activity (in which a determinant must be one or the other), this study found that certain factors, such as one's physical health, could serve as both barriers to and enhancers of physical activity. Similar to other studies (
Our findings that frequent barriers to physical activity for older adults include personal factors (e.g., health concerns, lack of personal safety, lack of ethnic-specific exercise facilities) and environmental factors (e.g., inclement weather, transportation, costs) are similar to findings from other studies (
Several factors limit the generalizability. First, the standard wisdom in focus group research is to conduct at least three focus groups for each group represented to saturate the data (
Despite these limitations, this study has important findings. Although there is interest in helping older adults adopt an active lifestyle, much of the published research continues to focus primarily on mainstream culture. This study used focus groups in the participants' first languages, allowing for an easier exchange of ideas. Rather than using one ethnic group, this study was able to compare results across seven ethnic groups. Also, participants in this study contributed important information about barriers and motivators in addition to specific recommendations for tailoring physical activity programming to multicultural audiences. Although generalizations cannot be made over the broader population, these groups have generated implications for practice that warrant further exploration. Knowledge of perceptions among older adults about motivators, barriers, and personally meaningful outcomes to physical activity is an essential first step to developing programs tailored to the values of each cultural group.
Future research could address several questions. To what extent does gender make a difference in being physically active as an older adult? This is particularly intriguing because men and women play different societal and cultural roles within most ethnic groups (
The importance of addressing the lack of physical activity among older adults in the United States is heightened by the increasing numbers of older adults, the pervasiveness of sedentary lifestyles in this age group, and the frequent barriers to activity. Listening to voices from multiple cultures, addressing barriers, and tailoring activity programs to meet unique needs is a promising approach to improving the health and well-being of the increasingly large numbers of underserved, ethnically diverse communities of older adults.
This project was funded by the Centers for Disease Control and Prevention, Prevention Research Center Program, with a grant to James LoGerfo, MD, MPH, at the University of Washington Health Promotion Research Center, Grant Number U48/CCU009654. The authors thank participants in the focus groups, facilitators and note takers, and community partners, including the Asian Counseling and Referral Service, Center for MultiCultural Health, Sea Mar Community Health Centers, and Seattle Indian Health Board.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
1. What does being physically active mean to you?
2. Describe what you do on a regular basis that involves physical activity.
3. What motivates you to do the kinds of physical activity you currently do?
What benefits do you get from being active physically?
Why is it important to you to keep physically active?
Health
Appearance
Emotional well-being
Being able to play with my grandchildren
Have done it in the past
Being with others
Getting out and seeing people
Walking to get somewhere
Enjoy going to a park in the neighborhood
4. What has kept you from being as physically active as you would like to be? Describe those circumstances.
Safety concerns in the neighborhood
Lighting
No sidewalks
Weather (cold/heat/rain)
Traffic
Neighborhood too hilly
Physically unable
Fear of injuries or falls
Lack of interest or motivation
Lack of money
Lack of transportation
Language barriers
No one to do it with
Places you need to go to are too far away to walk
5. If you could imagine the ideal program that would encourage you to be physically active, what would it look like?
A program that you would do on your own or in a group setting?
Outside or inside a building or both?
Number of days a week?
Duration of the class?
Characteristics of the instructor?
Cost?
Proximity to home (how far would you be willing to travel)?
Characteristics of Participants in a Study on Physical Activity and Exercise Among Underserved Ethnically Diverse Older Adults (n = 71), Seattle, Wash, 2002-2003
| 4 | 6 | 6 | 6 | 9 | 7 | 4 | 42 | ||
| 4 | 3 | 3 | 5 | 4 | 4 | 6 | 29 | ||
| 66.6 | 71.3 | 69.4 | 77.1 | 71.7 | 74.5 | 68.4 | 71.6 | ||
| 58-75 | 52-83 | 64-74 | 66-85 | 65-84 | 61-85 | 58-78 | 52-85 | ||
| 65.5 | 77 | 69 | 77 | 71 | 75 | 68 | 72 | ||
| 6.55 | 10.58 | 3.71 | 6.04 | 5.72 | 8.03 | 6.17 | 7.39 | ||
| NA | NA | 14.6 | 18.3 | 13.1 | 14.3 | 13.8 | 14.8 | ||
| NA | NA | 6-22 | 12-30 | 0-46 | 2-27 | 8-27 | 0-46 | ||
| NA | NA | 14 | 18 | 8.5 | 15 | 11 | 15 | ||
| NA | NA | 4.69 | 5.52 | 13.89 | 8.05 | 6.68 | 8.59 | ||
| NA | NA | 54.8 | 58.8 | 58.7 | 60.3 | 54.6 | 57.6 | ||
| NA | NA | 51-67 | 47-72 | 34-72 | 40-77 | 35-66 | 34-77 | ||
| NA | NA | 54 | 61 | 59 | 59 | 57 | 57 | ||
NA indicates not applicable. AI/AN indicates American Indian/Alaska Native, Af Am indicates African American, Can indicates Cantonese, Kor indicates Korean, Span indicates Spanish-speaking, Tag indicates Tagalog-speaking Filipinos, Viet indicates Vietnamese.
Physical Abilities of Participants in a Study on Physical Activity and Exercise Among Underserved Ethnically Diverse Older Adults (n = 71), Seattle, Wash, 2002-2003
| 7 (87.5) | 6 (66.7) | 6 (66.7) | 10 (90.9) | 7 (53.8) | 8 (72.7) | 10 (100) | 54 (76.1) | |
| 8 (100) | 7 (77.8) | 5 (55.6) | 10 (90.9) | 9 (69.2) | 9 (81.8) | 9 (90.0) | 57 (80.3) | |
| 4 (50) | 1 (11.1) | 9 (100) | 3 (27.3) | 2 (15.4) | 5 (45.5) | 7 (70) | 31 (43.7) | |
| 1 (12.5) | 1 (11.1) | 0 (0) | 0 (0) | 1 (7.7) | 0 (0) | 1 (10) | 4 (5.6) | |
| 1 (12.5) | 3 (33.3) | 0 (0) | 4 (36.4) | 9 (69.2) | 4 (36.4) | 2 (20) | 23 (32.4) | |
| 1 (12.5) | 4 (44.4) | 0 (0) | 4 (36.4) | 1 (7.7) | 0 (0) | 0 (0) | 10 (14.1) | |
| 1 (12.5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (18.2) | 0 (0) | 3 (4.2) | |
AI/AN indicates American Indian/Alaska Native, Af Am indicates African American, Can indicates Cantonese, Kor indicates Korean, Span indicates Spanish-speaking, Tag indicates Tagalog-speaking Filipinos, Viet indicates Vietnamese.
Strawbridge et al, 1992 (
Guralnik and Simonsick, 1993 (
Marcus et al, 1992 (
Features of Physical Activity Programming to Reach Ethnically Diverse Older Adults, Seattle, Wash, 2002-2003
Peer support or “buddy system” Option of group classes or individual instruction Share information about exercise benefits, location, and program availability Establish informal phone tree networks | |
Offer exercise classes at senior housing facilities Provide transportation to community programs from senior housing facilities Start a walking club at senior housing facilities | |
One-stop shopping: combine physical activity programs with meal programs, health education classes, language classes, social events, spiritual activities Provide transportation | |
Target programs to different levels of physical abilities Provide options for both groups as well as individuals | |
Target classes and programs toward older adults from similar cultural and linguistic backgrounds Recruit an instructor who speaks the language, communicates well, and holds similar values as the older adults Weave components of the culture, such as music or traditional dance, into the program |