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Physical Activity among Adults ≥50 yr with and without Disabilities, BRFSS 2001

BROWN, DAVID R.1; YORE, MICHELLE M.1; HAM, SANDRA A.1; MACERA, CAROLINE A.2

Medicine & Science in Sports & Exercise: April 2005 - Volume 37 - Issue 4 - p 620-629
doi: 10.1249/01.MSS.0000158189.17546.ED
Basic Sciences: Epidemiology
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Purpose: Before 2001, the Behavioral Risk Factor Surveillance System (BRFSS), a national survey of health behaviors, assessed only leisure-time physical activity. In 2001, the BRFSS used newly developed physical activity items to evaluate combined leisure-time, household, and transportation activities. Using BRFSS 2001 data, this cross-sectional study describes the prevalence of inactivity and insufficient and recommended physical activity for older adults (i.e., aged ≥50 yr).

Methods: BRFSS 2001 data were analyzed using prevalence estimates and logistic regression to assess physical activity patterns among older adults (N = 74,960) stratified by disability status, and select sociodemographic and health status characteristics.

Results: A total of 43.4, 39.1, and 17.5% of respondents without disabilities were active at a recommended level, insufficiently active, and inactive, respectively, taking into account nonoccupational physical activities. A total of 28.8% of older adults with disabilities were active at a recommended level, 35.7% insufficiently active, and 35.5% inactive. Among persons with and without disabilities, groups with the highest odds of inactivity and insufficient activity were women, persons aged ≥75 yr, blacks, persons with lower education levels and low incomes, and those who were obese.

Conclusions: Not all persons with disabilities can be active at recommended levels, but it is possible for the vast majority to do some types of physical activity, even if at insufficient levels. Thus, it may be possible for the prevalence of inactivity among persons with and without disabilities to be similar. This was not found. At the start of the new millennium, almost 60% of older adults without disabilities and 70% with disabilities were not obtaining a recommended amount of combined leisure-time, transportation, and household physical activity.

1Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity, Physical Activity and Health Branch, Atlanta, GA; and 2Department of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA

Address for correspondence: David R. Brown, Ph.D., Centers for Disease Control and Prevention, MS K-46, 4770 Buford Hwy., N.E., Atlanta, GA 30341-3724; E-mail: DBrown@cdc.gov.

Submitted for publication July 2004.

Accepted for publication November 2004.

Many health conditions such as cardiovascular disease, diabetes, obesity, and colon cancer are associated with aging, and regular physical activity has been found to improve primary and secondary prevention of these and other chronic diseases and disabilities (24). The scientific evidence linking physical activity to a multitude of health benefits has contributed to greater national efforts to increase physical activity among persons across the lifespan, including the older adult population, as one way to promote successful aging (15,17,22).

In October 2000, approximately 50 organizations and agencies representing the aging, public health, and physical activity fields convened in Washington, D.C., to emphasize the important benefits of physical activity among persons 50 yr and older, to identify barriers that impede this segment of the population from initiating and maintaining physical activity, and to develop strategies to overcome barriers. The proceedings led to the development of the National Blueprint for Increasing Physical Activity among Adults Aged 50 and Older(15). In 2001, a strategic planning guide, Creating Communities for Active Aging (17), was released to promote increased walking and bicycling among older adults. In June 2002, the U.S. Department of Health and Human Services also released a report (available at http://www.ahrq.gov/ppip/activity.htm) titled Physical Activity and Older Americans: Benefits and Strategies (22), which further emphasizes the need for older Americans to increase their physical activity.

Despite the increasing recognition that physical activity helps older adults maintain health and functional independence (15,23,24), many older adults report little or no leisure-time physical activity (7,9,11,12,26). On average, more than one third of adults aged 55–74 yr and 46% of persons aged ≥75 yr were inactive according to data combined from the 1994 and 1996 Behavior Risk Factor Surveillance System (BRFSS) (12). The prevalence of physical inactivity was higher for blacks than whites (12). Among whites, women were more inactive than men in the 65–74 and ≥75 age groups, but the prevalence of inactivity was similar among black men and women (12). Approximately one half of black men and women aged ≥55 yr were inactive (12). Using National Health Interview Survey data, it was also found that only about one third of adults aged 45–64 and ≥65 yr reported obtaining recommended amounts of moderate-intensity leisure-time physical activity (11). Women were less likely than men in these age groups to obtain recommended amounts of moderate-intensity leisure-time physical activity (11).

The BRFSS, a national survey of health risk behaviors, includes physical activity items that allow for assessment of prevalence estimates of physical activity among the U.S. adult population. Physical activity items that were used on the BRFSS from 1986 to 2000 primarily assessed leisure-time physical activity patterns (5). These assessments can be used to determine the proportion of the population active at levels sufficient to promote health and fitness, including enhanced cardiorespiratory functioning. In 1995, a public health recommendation was released that encouraged all adults to accumulate 30 min or more of daily moderate-intensity physical activity (18). This recommendation emphasized that a broad range of moderate-intensity lifestyle physical activities can lead to overall health benefits and perhaps some improvement in cardiorespiratory fitness. The 1995 recommendation was intended to complement but not replace prior physical activity recommendations that promoted health and fitness gains by prescribing continuous moderate and vigorous-intensity endurance activity (18; p. 404). Because of the focus on a greater range of lifestyle physical activities and the concept that daily duration of activity could be accumulated in short (e.g., 10 min) bouts, the 1995 recommendation was difficult to assess using BRFSS items on the 1986–2000 surveys (5). Items were therefore developed for the BRFSS 2001 to evaluate self-assessed moderate- and vigorous-intensity lifestyle physical activities that might accumulate on a daily basis. The BRFSS 2001 items evaluate household, transportation, and leisure-time physical activity domains (5). This study of older U.S. adults, defined as persons ≥50 yr of age, will determine baseline prevalence estimates of inactivity, insufficient physical activity, and recommended physical activity using the BRFSS 2001.

Unlike many previous studies, this research identifies physical activity prevalence estimates for older adults with and without disabilities. This study also focuses on age groups within the older adult population. Prevalence estimates of physical activity among persons with disabilities are often not stratified by age or available for select age groups. In a review chapter on physical activity and persons with disabilities, Heath and Fenton (10) point out that “people with disabilities are less active and have a lower work capacity than persons without disabilities” and that “an inactive lifestyle compounds the effects of the disability” (p. 195). Rimmer et al. (19) point out that a disability may be any condition that limits someone’s ability to perform normal daily activities. This definition could include chronic disabilities that occur in midlife and older age, such as osteoarthritis and diabetes. Rimmer et al. (19) conservatively estimated that approximately one third of the U.S. population has a disabling condition when disability is broadly defined, and the researchers point out that many of the conditions can be improved with physical activity. Despite the large number of persons with disabilities, Rimmer et al. state that “there remains a paucity of information on the activity patterns and physiological responses to exercise in persons with disabilities” (19; p. 1366). This paper helps fill the void, to some extent, by providing information on physical activity patterns among older persons with disabilities. Because efforts to increase physical activity may require separate targeted public health approaches that differ among older adults with and without disabilities, identifying physical activity rates for the two distinct populations seemed warranted.

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METHODS

Data source: Behavioral Risk Factor Surveillance System (BRFSS).

The BRFSS is a population-based, random-digit-dialed telephone survey administered yearly to a representative sample of noninstitutionalized U.S. adults aged ≥18 yr that inquires about various health behaviors, including physical activity behaviors and activity limitations (4). Disability, as defined in this article, refers to persons who, during the BRFSS 2001 survey, reported that they had activity limitations due to physical, mental, or emotional problems and/or they required the use of special equipment to perform daily activities. Respondents surveyed in the BRFSS 2001 were also asked whether they participated in nonjob-related moderate- and vigorous-intensity physical activities. The BRFSS has undergone Centers for Disease Control and Prevention institutional review board review and approval, and data obtained from the BRFSS are available in the public domain for secondary analyses. Verbal consent from respondents was documented before conducting the telephone-administered BRFSS survey. The BRFSS is described in more detail at http://www.cdc.gov/brfss.

The BRFSS 2001 was administered to 83,827 persons aged ≥50 yr in 50 states and the District of Columbia. Of these respondents, 1,743 observations were removed from the study due to missing disability data, resulting in 58,388 persons without disabilities and 23,696 persons with disabilities. Of these, 8.7% (N = 5,096) of persons without a disability, and 8.6% (N = 2,028) of those with a disability were missing physical activity data. These 7,124 persons with missing physical activity data were also removed from the study. After removal of 8,867 persons with missing disability and physical activity data, the final sample size was 74,960 persons, 53,292 (71.1%) without disabilities, and 21,668 (28.9%) with disabilities. The median response rate for the BRFSS 2001 was 51.1% (8), and it is possible that the response rate to the telephone survey might affect study findings such that the results are not representative of the U.S. population. However, it has been found that BRFSS data have minimal bias when compared with census data, and bias in the BRFSS data was not associated with response rate in 2001 (6).

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Physical activity items.

BRFSS 2001 respondents were asked two items to determine whether in a usual week they participated in moderate-intensity physical activities (causing small increases in breathing and heart rate) such as brisk walking, bicycling, vacuuming, or gardening, and/or vigorous-intensity physical activities (causing large increases in breathing and heart rate) such as running, aerobics, or heavy yard work. Respondents who indicated that they did moderate- or vigorous-intensity physical activity were also asked to report how many days per week they spent at least 10 min at a time doing the activities, and how much total time per day they spent doing the activities (see Appendix A for specific wording of the BRFSS 2001 physical activity items).

A validity assessment of the BRFSS 2001 physical activity items was conducted in which persons wore a heart-rate motion (HR+M) sensor for a week, and answered BRFSS physical activity questions at the end of the week (20). Spearman correlation coefficients were significant when comparing the HR+M and BRFSS vigorous-intensity physical activity assessments (r = 0.54, P = 0.005), and HR+M vigorous and BRFSS moderate and vigorous physical activity assessments combined (r = 0.46, P = 0.021). Correlation coefficients were not significant for the moderate-intensity physical activity assessments. The HR+M and BRFSS measures also resulted in 80% agreement in classifying study participants according to whether they met either vigorous (χ2 = 7.350, K = 0.61) or moderate and/or vigorous (χ2 = 6.625, K = 0.58) physical activity recommendations. Findings from the validation study indicate that individual differences between the HR+M and BRFSS methods were greater for moderate- than vigorous-intensity activity. They also show that the BRFSS items possess satisfactory validity for classifying respondents into physical activity groups combining moderate- and/or vigorous-intensity physical activities, and this classification method is used to define physical activity in this study.

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Physical activity definitions.

Physical activity recommendations prescribed to primarily improve fitness, such as improvements in aerobic capacity and body composition (1,2), have previously encouraged persons to obtain moderate- to vigorous-intensity physical activity ≥3 d·wk−1, ≥20 min per session. Although benefits to overall health can be derived by exercising at this level, the prescription was largely intended to promote cardiorespiratory endurance (24; p. 22). The physical activity public health recommendation promotes moderate-intensity physical activity and is intended to primarily enhance general health status. The physical activity prescription may confer some fitness benefits; however, the physical activity or exercise stimulus may not be sufficient to significantly improve cardiovascular fitness or promote significant weight loss. The public health recommendation encourages adults to “accumulate 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week” (18; p. 402). In many studies, “most days of the week” has been operationalized to mean ≥5 d·wk−1. In this study, respondents who reported doing ≥30 min·d−1 of moderate-intensity nonoccupational physical activity ≥5 d·wk−1, or ≥20 min·d−1 of vigorous-intensity nonoccupational physical activity ≥3 d·wk−1, were considered active at a level recommended for the U.S. adult population. Respondents who indicated that they participated in nonoccupational physical activity or exercise for at least 10 min at a time, but who were active at less than the recommended level, were defined as insufficiently active. Respondents were defined as inactive if they did not engage in moderate- or vigorous-intensity physical activity for at least 10 min at a time.

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Disability items: definition of persons with disabilities.

Persons with disabilities were respondents who answered yes to either BRFSS question 1) “Are you limited in any way in any activities because of physical, mental, or emotional problems?” or 2) “Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?” There were 19,633 persons who reported limitations because of physical, mental, or emotional problems, 8,616 persons who had a health problem that required use of special equipment to be mobile or perform daily activities, and 6,581 respondents who indicated both limitations due to physical, mental, or emotional problems and needing use of special equipment. Thus, there were a total of 21,668 (28.9%) persons with disabilities (19,633 + 8,616 − 6,581 = 21,668) in the study sample.

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Data analysis.

The percentage of adults ≥50 yr who were inactive or physically active at insufficient and recommended levels were determined for population subgroups using SUDAAN (Version 8.0, Research Triangle Institute, Research Triangle Park, NC) software to account for the complex sample survey designs and SAS (Version 8.2, Cary, NC) software. Because the stability of estimates based on small numbers is unknown, if the sample size of a subgroup was fewer than 50 persons, or the relative standard error (i.e., standard error divided by the estimate) was greater than 30%, the prevalence estimate was not shown (4). The study population was stratified by persons with and without disabilities; subgroups were further determined by characteristics that included sex, age (50–64, 65–74, ≥75), race/ethnicity (white non-Hispanic, black non-Hispanic, other), education (<12 yr, 12 yr/high school graduate, college/technical school 13–15 yr, college/technical school ≥16 yr), income (<$20,000, ≥$20,000), employment (employed, not employed), marital status (married/living with significant other, not married), children (any children aged ≤17 living at home, no children at home), body mass index (normal = BMI < 25, overweight = BMI 25–29.9, obese = BMI ≥ 30), general health status (excellent/very good, good, fair/poor), and cigarette-smoking status (current smoker, nonsmoker). Age classifications highlighted persons aged 50 yr and older because this segment of the population is the focus of the National Blueprint (15). Persons become eligible for Medicare benefits at age 65 yr, and this served as the rationale for determining another age cut point. Age ≥75 yr was the third age category used because past research has shown this age group to be the most inactive (12). BMI was determined by self-reported heights and weights calculated as weight (kg) divided by height (m2). BMI cut points were determined using clinical guidelines established by the National Institutes of Health (25). Polytomous logistic regression, using proc multilog in Sudaan, was used to compute odds ratios for physical inactivity compared with recommended physical activity, and insufficient physical activity compared with recommended activity. Unadjusted odds ratios were calculated for all variables except income. Income was not included because approximately 18% of the study sample had missing data. Only statistically significant variables (P ≤ 0.05) were retained for the adjusted analyses. The variable determining whether children ≤17 yr of age were living at home was the only variable not retained in the adjusted analyses. Separate polytomous logistic regression analyses were calculated for persons with and without disabilities.

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RESULTS

Approximately 60% of our study population were women, and this was true for persons with and without disabilities (Table 1). There were a higher percentage of men and women with and without disabilities aged 50–64, in contrast to the older age groups. Findings in Table 1 show that approximately one third of our overall study population were white men, and one half were white women. A higher percentage of persons with disabilities had <12 yr of education, earned <$20,000 annually, and were less likely to be employed than were persons without disabilities. More than one half (59%) of older adults without disabilities and 45% of persons with disabilities were married or living with a significant other. A vast majority (approximately 90%) of our study population reported no children ≤17 living at home. A higher percentage of persons with disabilities were obese in contrast to persons without disabilities, 31% and 19%, respectively. Persons without disabilities reported significantly better general health status compared with those with disabilities. Over one half (56%) of persons without disabilities reported that their health status was excellent or very good. Conversely, over one half (53%) of persons with disabilities reported only poor or fair health status.

TABLE 1

TABLE 1

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Prevalence of physical activity and inactivity among persons without disabilities.

For the total study sample, the prevalence estimates of inactivity, insufficient, and recommended physical activity are 23, 38, and 39%, respectively. The BRFSS 2001 prevalence estimates of recommended physical activity, insufficient physical activity, and inactivity among persons without disabilities are reported in Table 2. Overall, 43% of older adults without disabilities reported recommended amounts of physical activity, taking into account combined leisure-time, transportation, and household activities. Estimates of recommended activity were higher for men than women, and only one third of women ≥75 yr were obtaining physical activity at a recommended level. Thirty-nine percent of the study population without disabilities was active at insufficient levels, and women reported slightly higher insufficient activity than did men. Approximately 18% of U.S. adults aged ≥50 yr without disabilities were inactive. Women reported slightly higher prevalence estimates of inactivity. For both men and women, the prevalence of inactivity increased with increasing age. Men and women aged ≥75 yr had the highest estimates of inactivity, in contrast to their younger counterparts. More than 20% of men and almost one third of women aged ≥75 yr were inactive. White men and women had a higher prevalence of recommended activity and lower inactivity than black men and women. Recommended activity increased, and inactivity prevalence estimates decreased, with higher education levels. Higher income and employment were related to a greater prevalence of recommended and insufficient physical activity. Persons with higher income also reported a lower prevalence of inactivity. Persons married or living with a significant other had a higher prevalence of recommended activity and a lower prevalence of inactivity than persons not married or living with a significant other. The prevalence of recommended physical activity decreased with higher BMI. Obese persons had a higher prevalence of inactivity and insufficient activity compared with persons of normal weight and overweight.

TABLE 2

TABLE 2

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Prevalence of physical activity and inactivity among persons with disabilities.

Physical activity and inactivity prevalence estimates among persons with disabilities are reported in Table 3. Overall, 29% of older adults with disabilities reported that they obtained a recommended amount of physical activity. Prevalence estimates of recommended activity were higher for men than women. Less than 30% of women in all age groups reported recommended activity, and the prevalence of recommended activity by women decreased with higher age categories. Thirty-six percent of the study population with disabilities indicated they were active at insufficient levels. The prevalence of insufficient activity was not significantly different between men and women. Men and women aged ≥75 and men aged 65–74 yr reported a lower prevalence of insufficient activity compared with younger persons. Approximately 36% of persons with disabilities were inactive. Women reported a higher prevalence of inactivity. Almost 40% of women aged 65–74 yr, and over half of all women aged ≥75 yr, were inactive. Men with a disability fared somewhat better, but approximately 30% of men in the 50–64 and 65–74 age ranges, and 40% of men aged ≥75 yr, were inactive. White men and women reported more recommended activity and less inactivity than black men and women. Higher levels of education, employment, higher income, and being married or living with a significant other were associated with a greater prevalence of recommended activity and lower prevalence of inactivity. Obese persons had a significantly lower prevalence of recommended activity and significantly higher prevalence of inactivity, compared with persons of normal weight and overweight.

TABLE 3

TABLE 3

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Inactivity and insufficient physical activity compared with recommended activity by characteristic subgroups.

Table 4 displays the unadjusted and adjusted odds ratios for physical inactivity compared with recommended physical activity among persons age ≥50 yr. Among persons without disabilities, women had 1.2 (95% CI: 1.1, 1.2) times the odds of being inactive compared with men, and blacks had 1.7 (95% CI: 1.5, 1.9) times the odds of being inactive compared with whites. The odds of being inactive were also higher among people in the older age groups, compared with people age 50–64 yr. Persons ≥75 yr had 1.8 times the odds (95% CI: 1.7, 2.0) of inactivity compared with the reference group. Persons with <16 yr of education (i.e., <12 yr, 12 yr, college/technical school 13–15 yr) compared with those with ≥16 yr of education were at higher odds of inactivity, and highest odds were among those persons with <12 yr of education (OR = 2.3, 95% CI: 2.0, 2.6). Significantly higher odds of inactivity were also found among persons who were not married/living with a significant other (OR = 1.1, 95% CI: 1.1, 1.2) who were obese compared with those of normal weight (OR = 1.6, 95% CI: 1.4, 1.7) who reported fair/poor general health status compared with those reporting excellent/very good health (OR = 1.8, 95% CI: 1.6, 2.0), and who were current cigarette smokers (OR = 1.2, 95% CI: 1.1, 1.3). People who were not employed had 30% lower odds of being inactive compared with people who were employed (OR = 0.7, 95% CI: 0.7, 0.8). Results were similar among persons with disabilities, with the exception of employment status. Persons who were not employed had 1.3 (95% CI: 1.1, 1.4) times the odds of inactivity compared with those who were employed. Persons with disabilities reporting fair/poor general health status, or <12 yr of education, were also twice as likely to be inactive compared with the reference groups.

TABLE 4

TABLE 4

Odds ratios were also calculated for insufficient physical activity compared with recommended physical activity (results not listed in tables). Findings show equivalent, or smaller, nonsignificant odds ratios than were obtained for inactivity. Persons without disabilities were not only more likely to be inactive, but also insufficiently active for the following characteristics: women (OR = 1.2, 95% CI: 1.2, 1.3), blacks compared with whites (OR = 1.3, 95% CI: 1.1, 1.4), persons aged ≥75 yr compared with those 50–64 yr (OR = 1.3, 95% CI: 1.2, 1.4), persons with 12 yr of education and some college/technical school (13 to 15 yr of education) compared with those with ≥16 yr of education (OR = 1.2, 95% CI: 1.1, 1.3, for both comparisons), overweight (OR = 1.2, 95% CI: 1.1, 1.3) and obese persons (OR = 1.5, 95% CI: 1.4, 1.7) compared with persons of normal weight, and persons reporting good or fair/poor health status compared with excellent/very good health (OR = 1.2, 95% CI: 1.1, 1.3 for both comparisons). Persons without disabilities who were not employed had 30% lower odds of being insufficiently active compared with people who were employed (OR = 0.7, 95% CI: 0.7, 0.8), and these findings are similar to those for inactivity and employment status. Persons with disabilities were not only more likely to be inactive but also insufficiently active for the following characteristics: women (OR = 1.3, 95% CI: 1.2, 1.4), obese persons compared with those of normal weight (OR = 1.4, 95% CI: 1.2, 1.5), and persons reporting good (OR = 1.3, 95% CI: 1.2, 1.6) or fair/poor health (OR = 1.4, 95% CI: 1.2, 1.6) compared with excellent/very good health.

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DISCUSSION

This study describes prevalence estimates of physical activity among adults aged ≥50 yr, with and without disabilities related to activity limitations or use of special equipment to perform daily activities. The study is unique in that it provides initial prevalence estimates for older adults using newly developed BRFSS 2001 items. These items provide for a broader definition of physical activity that takes into account leisure-time, transportation, and household activities, whereas physical activity epidemiological and surveillance research in the past has focused largely on leisure-time physical activities and recall of formal exercise regimens. Our findings show that a substantial number of older adults are not obtaining enough regular physical activity to fully reap many of the benefits of physical activity. Only about 4 of 10 adults aged ≥50 yr without disabilities, and about 3 of 10 with disabilities, reported that they obtain recommended amounts of physical activity. Although it is hoped that all older adults with disabilities possess the potential to be physically active at recommended levels, it is possible that some persons may not be able to achieve this amount of activity due to the nature or severity of their disabling condition. Although not all persons with disabilities may be able to be active at recommended levels, it is possible for the vast majority to do some types of physical activity, even if at insufficient levels. Thus, it may be possible for the prevalence of inactivity among persons with and without disabilities to be similar, but this is not what we found. The good news is that less than 20% of older adults without disabilities were inactive. This good news is in stark contrast to the 36% of older adults with disabilities who report being inactive.

These findings reinforce our decision to compare persons with and without disabilities, which is not often done in physical activity surveillance reports. We stratified by disability status to control for the possibility that physical activity limitations per se may contribute to inactivity or insufficient activity levels, and because prevalence estimates may inform public health research, policy, and practice separately for older adults with and without disabilities. On one hand, stratifying people based on disabilities seems to run counter to the appropriate public health mission, which should be a “physical activity for all” approach. Persons with disabilities are, after all, part of the general population, and arguments can be made against stratifying based on disabilities. On the other hand, public health strategies (e.g., audience segmentation, communications and targeted campaigns, policy development, etc.) often require that select populations be viewed distinctly to promote and improve their health behaviors and health status. Our findings confirm that not enough older adults are active at a recommended level, and that this problem is even more alarming among older adults with disabilities.

It is interesting that the estimates of insufficient activity among older adults with and without disabilities were not too disparate. Thirty-six to almost 40% percent of the study population with and without disabilities, respectively, were active, but at less than recommended levels. It is therefore very important for epidemiologic research to begin to evaluate the health benefits associated with insufficient physical activity. The physical activity and public health recommendation rests in part on the idea that some physical activity is better than none. At this time, however, it is unclear to what extent the benefits of insufficient activity, as defined using the BRFSS 2001, are lesser than those associated with recommended activity, and greater than those associated with inactivity. Using this population-based survey, we would hypothesize that inactive people possess poorer health status than insufficiently active people. If these findings are confirmed, they would be very pertinent to the older adult population, which may potentially gain numerous and important benefits from increasing physical activity to even less than a recommended level.

This study also evaluated differences among physical activity and inactivity behaviors by select sociodemographic and health characteristics of the respondents. Although the entire population of inactive and insufficiently active older adults needs to increase physical activity, subsegments of the population will require greater attention and efforts to change behavior. Research has shown that high rates of inactivity are reported by subgroups of the general adult population, including older adults, women (depending on how physical activity is defined), racial and ethnic groups other than white, and people with low education levels and low incomes (11,24). The same demographic differences emerged within the older adult population studied here. Our findings confirm that strategies for promoting and increasing physical activity among older adults are greatly needed that will resonate with women, persons aged ≥75 yr, persons from racial and ethnic groups that differ from the dominant culture, persons of low income and low education, and persons who are obese. These findings are true for older adults with and without disabilities, but are even more salient among the population with disabilities.

A primary goal of this research is to establish baseline prevalence estimates for inactive and physically active older adults using the BRFSS 2001. It is very difficult to compare prevalence rates found in this study to those obtained in previous studies, because items on the different surveillance systems differ. It is important for health professionals to keep in mind the domains and types of activities assessed by different national surveillance systems, and how factors such as frequency, intensity, and duration are determined. Also in this study, we report prevalence estimates separately for persons with and without disabilities, whereas many prior studies report combined estimates for persons with and without disabilities. One study using data from the 1991 National Health Interview Survey, however, found that 30% of persons with disabilities were inactive (i.e., they obtain no leisure-time physical activity). It was also found that “27% of persons with a disability, compared with 37% of persons without a disability engaged in regular moderate physical activity” (10; p. 204). Although these findings pertain to younger and older adults combined, and are generated from an assessment of only leisure-time physical activity, they are not too disparate from our findings.

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Study limitations.

This study has several limitations. First, physical activity prevalence estimates generated by the BRFSS 2001 are based on self-reported data. Limitations with self-report physical activity questionnaires have been reported previously (3,14), and some misclassification of our respondents across activity categories may have occurred as a result of recall bias or a tendency by some to answer in a socially desirable manner. Based on our definition of disability, we are also unable to assess the extent to which persons with disabilities in our study may have mental or emotional problems that threaten the validity of their responses. Self-report physical activity measures are also problematic if the goal is to determine individual energy expenditures. However, self-report measures can be used to group people into categories of habitual physical activity, and despite their limitations they remain the most efficient approach to use in epidemiological and surveillance efforts (3,14). Second, the BRFSS 2001 evaluates moderate- and vigorous-intensity lifestyle physical activities. Items on the BRFSS 2001 survey, however, lack the specificity to determine prevalence estimates for specific domains of activity (i.e., leisure time, household, and transportation), as well as specific types of activities (e.g., walking, bicycling, etc.). Third, the definition of disability used in this study is based on self-reported activity limitations or use of special aids. It is not possible to identify the specific conditions causing the limitations. Nor is it possible to determine whether the onset of the conditions are due to the aging process per se or are primary disabling conditions that are now persisting in older aged individuals. Fourth, our data do not include information about people living in nursing home residences or other institutional settings.

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CONCLUSIONS

Studies have shown that older adults (11) and people with disabilities (10) do not obtain adequate amounts of regular leisure-time physical activity. BRFSS 2001 survey items asked respondents to report the amount of physical activity they obtained, taking into account the frequency and duration of moderate- and vigorous-intensity leisure-time, household, and transportation activities combined. Even using multiple domains of nonoccupational physical activities to define activity categories, almost 60% of older adults without disabilities and 70% of older adults with disabilities did not obtain a recommended amount of physical activity necessary to receive substantial health and fitness benefits. Older adults represent the fastest growing segment of the U.S. population (15,16,21). Although it is not clear whether physical activity can prevent physical disabilities (13), physical activity can help older adults maintain or improve function, fitness, and health (13,15). Physically active lifestyles also hold promise for reducing the severity of secondary conditions associated with a primary disability, although greater research is needed to document these effects (19). It is imperative that greater program and research efforts be made to increase physical activity among persons 50 yr and older.

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APPENDIX A.

Table. Be

Table. Be

Keywords:

EXERCISE; SENIORS; ELDERLY; OLDER ADULTS; ACTIVITY LIMITATIONS

©2005The American College of Sports Medicine