Life in our Years Unlocking physical activity participation for older adults - Partnered by: ukactive
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Life in our Years Unlocking physical activity participation for older adults Partnered by:
Table of Contents
Forewords 4
Acknowledgements 6
Executive Summary 7
Introduction 8
An ageing population and the cost to society 8
Physical activity benefits for older adults 8
Overcoming barriers to physical activity participation 9
Older adults in our sector (membership and preferred activities) 9
Aims and objectives 10
Methodology 11
11
Phase 1 – Case study submission
11
Phase 2 – Input from older adults
Findings, Discussion & Recommendations 12
Accessibility 13
Flexibility and range of offerings 13
Frequency of offerings 14
Timing and booking options 15
Atmosphere 16
A sense of welcome and comfort 16
Belonging and inclusion 16
Facility upkeep 16
Socialising 17
Socialising provides camaraderie and enjoyment 17
Socialising seen as an integral part of offerings 17
2
Table of Contents
Instructors 18
Instructor knowledge (technical skill and health) 18
Instructor attention and feedback 18
Instructor communication and interpersonal skills 18
Categorisation and Promotion 19
Categorise by ability not age 19
Promotion of intergenerational mixing 20
Ensure transparent communication 21
Long-term support for physical health following the pandemic 22
Improve accessibility 22
Build confidence through re-introduction into fitness 22
Continue digital offerings 22
Actively integrated healthcare systems 23
Future research 24
Conclusion 25
References 26
3
Forewords
It is well documented that the UK is Firstly, it is an opportunity for the engine
becoming a progressively older nation in room of activity in this country – gyms,
both absolute and relative numbers, and pools, and leisure centres – to play an even
this has profound implications for a number bigger role by digesting the important and
of key institutions that support our daily constructive feedback within the report
lives. Longer life expectancy is not by itself a from that target audience on how and why
problem. The problem is that the number of they would use these facilities more. The
those years spent heavily dependent on key themes and recommendations in this
others is not decreasing, in fact in some report – accessibility, atmosphere,
groups it may be increasing and this importance of social interaction (particular-
increases the need for health and social ly with purpose), workforce engagement,
care. and promotion – are important learnings for
our sector and will help develop and build on
Furthermore, this situation is compounded the great work already taking place.
by the legacy of the Covid-19 pandemic and
the impact of lockdown, where our wider Secondly, this report is an opportunity to
health needs have been side-lined by the drive the development of strong and
Huw Edwards urgency to address this crisis, and a political
climate where our leaders are still looking to
irreversible partnerships with health
agencies, including the NHS, and the sector
CEO, ukactive answer the unreconciled issue of long-term must be involved in the new Health and
social care provision. Care Partnerships announced in the White
Paper titled ‘Integration and Innovation’. One
It is clearly therefore a national priority to of the positives of the past year has been
find solutions within society to increase the the profile on the essential services we
number and proportion of years that people provide across our facilities and services,
live in good health. The case for this was showcasing a breadth of programmes that
made very effectively in the recent APPG have a direct role in improving the nation’s
Longevity report – Levelling Up Health – physical, mental, and social wellbeing.
which championed a new Health Improve- Looking forward, this report, and the
ment Plan that places preventative adoption of the recommendations, can
measures at the heart of the solution. become the catalyst for developing the
robust pathways from GPs and Allied Health
We must also ensure the strongest possible Professionals (AHPs) to these facilities and
case is made for increasing activity – to sports medicine and rehabilitation
physical, cognitive and emotional – as we services such as geriatric medicine – an
live longer, and that this is part of the agenda that has an overwhelming support
package of solutions we embrace as a of the older people who contributed to this
nation. report.
Professor Sir Muir Gray This is hugely important as it is an area
where significant progress needs to be
It’s now important that we take this report –
its learnings and recommendations – and
Director of the Optimal Ageing made. Despite the known benefits of regular bring them to life. We want to move the
Programme for Living Longer Better physical activity, only 53.8% of adults over recommendations from the pages they are
the age of 55 complete the recommended written on into the thousands of gyms,
150 minutes of moderate intensity physical pools, and leisure centres that exist within
activity per week. Furthermore, just over a every community. ukactive will now work
third (34.4%) complete less than 30 minutes with partners across our sector and the
per week and are therefore classified as wider health community to make this a
inactive. reality so our sector can play its fullest role
in improving the nation’s health and
So this is why this report is vital and wellbeing.
provides an opportunity to make some real
changes.
4
Forewords
This industry wide collaboration, driven by As part of this collaboration, de-personal-
ukactive and supported by EGYM, is an ised data collected from almost 250,000
incredibly important and insightful piece of EGYM Smart Strength Series users has
work. been independently analysed by the
ukactive Research Institute to show the
The UK population is ageing at an astound- positive impact resistance training has on
ing rate. The Office of National Statistics muscular strength in older adults. The
predicts, 75 per cent of UK population results are compelling.
growth between 2012 and 2040 will be in
the over-60 age group, with increases from The challenge for the general population,
14 to 22 million. Within this group, the including older adults, and the opportunity
fastest growing segment is those aged 85+. for the physical activity sector lies in the
This is leading to an exponential rise in the fact that, whilst increasing safely and
number of UK Centurions with over effectively increasing aerobic activity is
600,000 UK citizens expected to live beyond accessible to most through basic activities
100 by 2070. such as walking or cycling, most people do
not have the knowledge or access to the
Kerstin Obenauer As a result, ‘older adults’ represent a huge
opportunity for the physical activity sector,
equipment necessary to be able to
self-prescribe an effective and safe
Country Director, EGYM UK both in terms of commercial return and in resistance training programme. This is
terms of the wider value we can contribute where the sector can really demonstrate it’s
to society. value, utilising the expertise of our hugely
talented workforce and our specialist
Whilst generally encouraging older adults to equipment.
increase their levels of general activity is, of
course, a step in the right direction, as the This report highlights the excellent work
experts in physical activity prescription, it is already taking place across the UK,
important that we, as a sector, also encouraging
recognise not all forms of physical activity engagement with older adults and driving
deliver an equal health and wellbeing positive health outcomes. It also provides a
return. series of practical recommendations that, if
implemented, will further enhance our offer,
Whilst there is obvious merit in encourag- helping older adults maintain health,
ing more older adults to achieve the Chief happiness and fulfilment for longer whilst
Medical Officer’s recommended 150 minutes relieving the burden on social and health
of aerobic activity per week, there is care services.
increasing evidence that incorporating an
element of resistance training can positively
influence an array of health and wellbeing
indicators including: mobility, strength,
bone density, mental health and long term
metabolic conditions such as diabetes.
5
Acknowledgements
We would like to thank all of the individuals
and organisations who contributed to this
research. Throughout each phase of this
project, we have required input, knowledge,
and time from a range of individuals,
without whom we would not have been able
to produce these findings and
recommendations.
To those who supported ukactive by
submitting case studies or disseminating
our call for evidence, your engagement with
the research has helped us paint a picture of
how tremendously hard the fitness and
leisure sector is working to address the
barriers to physical activity participation
experienced by older adults, and
recommend pathways for continued
improvement. We hope that this report will
support you in your individual and collective
missions to increase physical activity
participation among older adults.
To the 427 people who volunteered their
time to review case studies and the 57 who
also took part in our online focus groups,
thank you for your input, experiences, and
expertise, which have enabled us to
understand the ways in which the fitness
and leisure sector can better support you to
be physically active. Your participation has
directly influenced our interpretation of the
findings and development of the
recommendations. We hope that this report
will ensure the fitness and leisure sector
supports older adults to engage in regular
physical activity and lead healthy and
independent lives.
6
Executive Summary
The population of the United Kingdom (UK) highlighting what impacts older adult's The offerings presented a range of
is progressively getting older, a trend decisions to engage in offerings, from which approaches to support older adults to be
expected to continue. Healthy ageing can be nine recommendations were produced. active with specific targeting, approaches,
achieved through physical activity These themes and recommendations delivery, links and evidence. This
participation and is essential to supporting include: demonstrates the breadth of great work
older adults to lead independent lives, that the fitness and leisure sector is
increasing healthy life expectancy, and 1. Having easy and accessible offerings that currently doing and the extent to which
reducing pressures on the overstretched utilise customer feedback to make older adults themselves feel these offerings
NHS and social care system. However, necessary adaptations to scheduling (e.g. meet their activity needs.
despite this, physical activity levels in older flexibility in frequency, booking options and
adults (55+) remain low, with only 53.8% range of activities) and that support needs To ensure that offerings are continually
being classified as ‘active’. The fitness and of older adults centred around maintaining refined and developed for older adults, it is
leisure sector has a unique position to strength. also recommended that future research
support the activity levels of older adults. consider the consistent capture of evidence
Yet, while barriers and challenges to older 2. Create, build and maintain a welcoming in this area. This should include measuring
adults physical activity participation have and inclusive atmosphere to increase the sector impact of the implementation of
previously been explored, understanding likelihood of repeat usage, through fostering the recommendations on older adult's
examples of what the fitness and leisure a sense of community and rapport between health, behaviour change and the local
sector is currently doing and how this is the workforce and customers and health care systems.
perceived by older adults is not fully maintaining high standards of safety and
understood. Therefore, this research aimed facility upkeep. The physical activity sector is
to: well-equipped to support healthy ageing
3. Maintaining and increasing socialising and healthy life expectancy, and can help to
1. Determine the sector’s offer to support opportunities through offerings in order to ease pressures on the healthcare system,
over 55s to be physically active. support physical, mental and social health, the economy, and support the UKs recovery
improve experience and drive attendance. from the Covid-19 pandemic. This report has
2. Gain insight from older adults on the outlined the many ways in which the fitness
extent to which these offerings meet their 4. Preparing the workforce with the people and leisure sector leverages its expertise to
needs and wants. skills to deliver high quality offerings engage older adults in appropriate, safe and
primarily with knowledge on effective opportunities for physical activity,
3. Produce recommendations for the sector communication and interpersonal skills, and to support physical and mental health
to expand and improve these offerings. and an understanding of common health outcomes. The recommendations in this
conditions and how to adapt exercises to report are designed to support the sector to
A mixed methods research approach was individual health needs. expand and enhance existing offerings for
utilised which included the submission of older adults, thereby further cementing its
physical activity offering case studies from 5. Appropriately categorising and reputation as an essential health service to
across the fitness and leisure sector communicating offerings to maximise the nation.
followed by a review of the case studies and attendance by a) categorising by ability or
focus groups with older adults to identify if intensity, not age; b) providing clear and We hope that the recommendations drawn
and how offerings meet their needs and detailed information about what offerings from this research provide clear and
desires. A total of 124 case study include and ability level and c) advertising tangible actions for all parts of the fitness
submissions were received from a wide intergenerational mixing. and leisure sector as well as any
range of fitness and leisure sector offerings interconnected sectors to continue to
directly delivering to older adults, training 6. Ensuring offerings support physical develop and evolve their activity offerings,
individuals to work with older adults or health and integrated health care systems ensuring that older adults are supported to
providing exercise equipment for older long-term following the pandemic by lead a healthy, independent life for as long
adults. A total of 86 reviews of the case providing sessions that address changes in as possible.
studies were provided by older adults and physical ability, supporting physical
53 older adults took part in focus groups. rehabilitation of older adults from Covid-19,
Combined analysis identified six themes and continuing a digital-hybrid approach.
7
Introduction
An ageing population and the cost to Physical activity benefits for older adults to society, particularly against the backdrop
society of an ageing population and an
Many important aspects of healthy ageing, overstretched health and social care
The population of the United Kingdom (UK) and healthy life expectancy, can be system.
is progressively getting older, and this trend supported through regular physical activity.
is expected to continue. For example, over Despite the known benefits of regular
8-11
65-year-olds make up 18.0% (11.8 million These include : physical activity, only 53.8% of adults over
people) of the UK population and are the age of 55 complete the recommended
expected to reach 26.0% (20.4 million • Good physical and mental function, 150 minutes of moderate intensity physical
people) by 2066. In comparison, the • The reduction of falls and fall-related activity per week and are to be classified as
16-64-year-old population is only expected injuries, active. Just over a third (34.4%) complete
to increase by 2.1 million people over this • Improved sleep, less than 30 minutes per week and are
1
time . • Opportunities for social interaction and therefore classified as inactive14. Within the
reduced loneliness, 16-54 age group, 66.2% are considered
As the population continues to age, we must • Helping individuals to deal with disease active while 22.4% are classified as
14
ensure older adults are supported to lead symptoms and functional limitations inactive . Whilst 150 minutes of moderate
healthy and independent lives for as long as through feeling in control and responsible intensity physical activity every week
possible. While life expectancy has for their own health and wellbeing classifies an individual as active, the
increased over time, healthy life expectancy recently updated physical activity
has not increased by the same extent, Physical activity also promotes positive guidelines from the UK Chief Medical
11
meaning the population is living longer, but economic and social outcomes, which can Officers’ (CMO) also indicate that older
12
more of those years are spent in poor be achieved through the : adults should include muscle strength,
2
health. This disparity has a considerable balance and flexibility exercises twice a
impact on the social care system and adds • Prevention of 900,000 cases of type-II week. Specific to the fitness and leisure
to the overstretched capacity of the NHS. diabetes and 1.5 million back pain cases sector, ukactive’s Moving Communities
The NHS currently has the longest waiting every year, generating a total of £4.1 billion report highlights that 23% of public leisure
list for planned hospital treatment such as in healthcare savings every year. memberships are held by adults over the
15
knee and hip replacements since records • Prevention of 30 million GP visits, reducing age of 55 , yet public leisure accounts for
began, with a total of 5.12 million people pressures on an already overstretched NHS. only one part of the fitness and leisure
waiting, of which just over 385,000 people sector. This highlights the need for a wide
3
have been waiting for over a year . As we More recently and in light of the global range of opportunities and support for older
age, chronic diseases and long-term health Covid-19 pandemic, evidence suggests that adults to be active, especially as the
conditions become more prevalent and as a meeting the recommended levels of guidelines may seem daunting for those
result account for a sizeable portion of GP physical activity was associated with taking part in little to no regular physical
(50%) and outpatient (64%) appointments, reduced risk of severe Covid-19 outcomes activity.
inpatient bed days (70%), and overall health (hospitalisation, admission to intensive care
and social care expenditure (£7 of every unit [ICU] and death), and that even doing As highlighted in the recently updated
4
£10) . Adult social care accounts for over some activity was better than none in physical activity guidelines, strength and
13
40% of local authority spending and has reducing this risk . Increasing physical balance, as well as general movement, are
increased each year since 2014/2015 to an activity levels may help healthy ageing as important for older adults. Strength is
5
estimated £23.1 billion . A further £6.9 billion well as help prevent the threat posed by associated with improved function, reduced
is expected in 2020/2021 due to the impact Covid-19 and potentially future epidemics morbidity, and reduced risk of premature
5 16-18
of the Covid-19 pandemic . While or pandemics by boosting the immune mortality . Strength increases in early
13
expenditure increases, government funding system . This demonstrates demonstrating adult life but declines with age at
5 19-23
to local authorities has been decreasing , the importance of regular physical activity approximately 1% per year .
contributing to existing pressures on the
social care system and reducing its
long-term sustainability.
A longer life presents opportunities for
commercial organisations who can
successfully innovate to achieve business
expansion and diversity by fully
understanding the opinions of older adults
6
and their role within society . However, it
has been suggested the commercial
businesses are unprepared to meet the
needs of older adults with gaps in products
and services based on what older adults
6
actually want . Given that it has been
estimated that over 50’s hold approximately
7
70% of the wealth , understanding the needs
of older adults combined with innovative
approaches to provide appropriate services
may present an area for commercial growth.
8
Considering the important role of strength, Overcoming barriers to physical activity uptake of physical activity, utilising exercise
it has been argued that both early participation referral pathways that work, sticking to the
development of strength capacity24 and evidence for the population, and monitoring
31
lifetime engagement in resistance training The Government aims to ensure that for outcomes and improvements .
are important to slow the typical rate of everyone can enjoy at least five extra
25,26
decline with age . Recent research healthy, independent years of life by 2035, The health status and physical activity
suggests older adults can ‘bend the ageing and has committed to reducing the healthy enjoyment of over 60-year-olds influences
32
curve’ 27 with long-term participation in life expectancy gap between affluent and activity participation . Linked to health
28
resistance training. This is further deprived communities . Physical activity status, positive physical activity behaviour
supported by big data from EGYM analysed can play a vital role in achieving this change often occurs in the event of a health
by the ukactive Research Institute, where ambition, yet in order for the many benefits scare and tends to be combined with
EGYM users were engaged in an automated, of being physically active to materialise, influence from family or friends32.
smart strength equipment training current barriers to participation need to be Encouragement by family and friends in
programme, which included regular overcome. Attitudes towards physical addition to clinicians has been suggested as
strength testing and progressive training activity participation among older adults a route to improve participation33. However,
adapting strength parameters over time. are mixed; some older adults (aged 60 or Age UK 32 have suggested that undertaking
Examining the trajectory of strength in above) perceive physical activity to be more physical activity for health benefits
almost 250,000 EGYM users aged over 55 unnecessary or even harmful, whilst others alone was not enough to justify behaviour
showed substantial increases in strength see the benefits but encounter barriers to change.
29
with maintenance occurring over time participation . It has been suggested that
(Figure 1; solid orange line), in contrast to the improving population health requires a Instead, messaging linking physical activity
expected decrease in strength that would visible and vocal public champion to set out with mobility and independence was found
happen with ageing (Figure 1; dotted orange what needs to be done, and challenge key to be more effective. Activity classes aimed
30
line). This is shown for leg press strength players to do more . At the local level, this at older adults were seen as less appealing
due to the importance of the lower body includes the promotion of social movements as many individuals did not feel they
musculature for the maintenance of daily for healthier lives as well as businesses classified as older adults, whereas classes
functional ability; though the trajectory is playing a vital role in the health of the focused on ability were viewed more
32
similar for other muscle groups. The nation30. Furthermore, non-medical favourably . Combining physical activity
increase and maintenance associated with pathways to support healthy ageing and with opportunities to socialise were also
strength training compared to the natural help prevent falls, such as those provided by seen as positive ways to increase activity
32
decline over time demonstrates the the fitness and leisure sector, could levels , alongside keeping costs low and
importance of early and continued democratise delivery with a sufficient level enjoyment high, delivering activity in a
engagement in effective strength training of challenge to the right people, at the right group setting, and supporting individuals to
31 33
for older adults. This presents a key area for time, and by the right workforce . This raise their self-efficacy for physical activity .
the fitness and leisure sector to support includes raising awareness that falls are not
older adults. an inevitable part of ageing, encouraging There are a range of barriers that may
discourage older adults to take part in
Figure 1. Strength gains in persons over 55 years of age engaging in EGYM resistance training regular physical activity. Previous research
presents a number of ways in which older
150
adults can be supported to overcome these
barriers, many of which can be
implemented by the fitness and leisure
sector. This presents opportunities for the
fitness and leisure sector to support older
125 adults to be more physically active.
Older adults in our sector (membership and
preferred activities)
100
A concerted effort is required to provide
support and opportunities for physical
activity to help older adults maintain
independence and reduce the cost burden
75
of social care34. There are a number of ways
in which the fitness and leisure sector can
lead this agenda. However, whilst the
barriers and challenges experienced by
50 older adults have been identified,
0 100 200 300
understanding the examples of what the
Time (weeks) fitness and leisure sector is currently doing
and how this is perceived by older adults
Key Strength Gain with Resistance Training Normal Age Related Decline without Resistence Training themselves is not fully understood.
Research is required to gain a greater level
Note: Data is for EGYM users over 55 years of age (n = 248,492)
A linear-log mixed model was fit to these data: Isometric Strength ~ log(Time) + (log(Time)|Participant) of understanding of the fitness and leisure
Model fitted values were then transformed to % changes from baseline (i.e. the model intercept) sector’s offer to support older adults to be
physically active.
9
Aims and objectives
In light of the need for further evidence and
ukactive’s ambition for a healthier, happier
and more active population, the ukactive
Research Institute undertook a research
consultation across the fitness and leisure
sector, which aimed to:
1. determine the fitness and leisure sector’s
offer to support over 55s to be physically
active.
2. gain insight from older adults on the
extent to which these offerings meet their
physical activity needs and what they
would like to see as part of offerings,
including any changes brought about due to
the Covid-19 pandemic.
3. produce recommendations for the fitness
and leisure sector to improve the physical
activity offerings for older adults and
contribute to increasing physical activity
participation levels among older adults.
The threshold and terminology set and used
35
by Sport England for older adults was
adopted as part of the research
methodology, meaning data was collected
on and from any person aged 55 years and
above. Data themes, findings and any
references to older adults throughout the
rest of this report is thus based on insight
from individuals aged 55 years and above.
10Methodology
A mixed methods research approach was Phase 2 – case study review and focus Through the case study review and focus
utilised to meet the aims and objectives of groups with older adults groups older adults were asked to identify
the research and this was undertaken aspects of offerings that discouraged taking
across two phases (see Figure 2 for an Case studies were reviewed by a cohort of part in physical activity offerings (problem
overview). older adults, followed by focus groups identification), aspects that were important
(objective 2). A group of older adults (55-90 to them and encouraged them to take part,
Phase 1 – case study submission years old) with varied physical activity as well as additional aspects that could be
participation both in and outside of fitness implemented to support more individuals to
Case study submissions from a wide range and leisure facilities were recruited through be active across the fitness and leisure
of fitness and leisure sector offerings ukactive members and partners to take sector (decision making and solution
directly delivering to older adults, training part in this stage. Phase 2 took the shape of generation). In addition to the above, the
individuals to work with older adults or a qualitative task orientated group process focus groups also explored the experiences,
providing equipment for older adults to where participants direct problem opinions and perceptions of the role the
exercise (objective 1) were sought. This identification, solution generation, and physical activity, fitness and leisure sector
involved an open-call across ukactive’s decision-making called Nominal Group can play in supporting their physical and
membership and wider network to provide Technique (NGT)36, 37. Here NGT utilised the mental health post the Covid-19 pandemic.
examples of solutions, programmes, experience and knowledge of older adults to Five one-hour long focus groups were
offerings, initiatives and commissioning identify what they felt was appropriate to conducted with 53 older adults by the
models in place across the sector. An online best support them and other older adults to ukactive Research Institute. These were
survey platform (open between 7th October be physically active and use physical recorded, transcribed, and analysed using
2020 and 9th February 2021) collected the activity offerings. thematic content analysis, a process which
case study submissions through open and identifies re-occurring patterns in the data
closed questions (the full survey can be and then categorises patterns into prevalent
38
seen HERE). themes and sub-themes .
Figure 2. Research process: Fitness and leisure sector offerings to support adults over the age
of 55 to be physically active.
Open Call Collation Case Study Focus Groups Report
to the fitness and and review by the review by older adults to further explore the of the key findings
leisure sector for ukactive Research to provide feedback key elements of and produce
offerings that support Institute, and case and rate importance offerings to support recommendations to
older adults to be study preparation of offerings older adults be active support older adults
active be active
11Findings, Discussion &
Recommendations
A total of 124 case study submissions were interventions that were continuous. Older Key themes highlight that older adult's
received from across the UK on current adults who rated activities highly, the top decisions to engage in physical activity
offerings designed to support older adults to three activities within these case studies through offerings was impacted by:
be physically active, demonstrating the were group activity classes, resistance
breadth of the fitness and leisure sector’s exercises and chair-based exercises. 1. How accessible they are and how much
activity provision targeted to older adults. Offering outcomes that were rated as highly they cater for their physical needs and goals
Many of the offerings aimed to support important centred on offerings that
physical activity participation (60%) and increased physical activity levels, strength 2. How it feels to attend them
improve physical health (52%) of older and balance, social connections, and
adults. Mental health (28%) and social or personal wellbeing. 3. How many opportunities there are for
community support (21%) based aims were social interaction
also common with ‘other’ (17%) aims Six themes were identified from the case
targeted at education, using nature, social study submissions, reviews and focus group 4. How they are led or instructed
housing support, and diet or weight analysis. These themes provide key areas
management also cited. that should be considered to develop 5. How they are categorised and promoted
offerings that support older adult physical
For phase two, 86 case study reviews from activity participation across the fitness and 6. How they support physical health and
older adults were received. Based on these leisure sector. integrated health care systems long-term
reviews, older adults rated the offering type, following the pandemic.
offering outcomes, and activities provided
as some of the most important factors for Each of these themes are explained in detail
engagement. Older adults who rated the below, with aligning recommendations for
offering type as ‘high’ reviewed case studies the sector to take forward.
that primarily provided programmes or
12Accessibility Flexibility and range of offerings of activities available to pick from, which
indicates that current offerings have taken
Accessibility of offerings emerged as a key Flexibility in offerings, including their fee this into consideration. Group activity
theme (Figure 3) throughout the case study options, range of activities, frequency, and classes were provided by 70% of the case
reviews and focus groups. This refers to timing, was noted as important to older study submissions which also reflects the
flexibility in the structure and range of adults. With regard to paying for an offering, types of offerings most frequently spoken
activities as part of the offering, frequency the case study submissions indicated that about by older adults in the focus groups.
of the offering, timing and booking options an individual paying for an offering through This was followed by more specific offerings
associated to the offering, as well as the fees per session (53%) or memberships similar to group activity, like resistance
location and length of the offering. by: (weekly/monthly/annually; 36%) were exercises (59%), chair-based exercises
(61%), falls prevention and strength and
Figure 3. Accessibility sub-themes. balance (55%) activities. As presented in the
introduction, examination of EGYM strength
data showed substantial increases in
Accessibility strength with maintenance occurring over
time, in contrast to the expected decrease
in strength that would happen with ageing,
supporting the concept of long-term
participation in resistance training ‘bending
Flexibility and Timing and 27
the ageing curve’ . Given that resistance
Frequency of
range of booking exercise and strength and balance activities
offerings
offerings options are common offerings provided by the
fitness and leisure sector, engaging older
adults in these offerings as early as possible
could have a substantial impact on the
The most common offering type was frequent, as were offerings that had no fee strength abilities of this population,
continuous programmes or interventions (36%). A number of older adults highlighted supporting and maintaining independence.
supporting older adults, provided by 75% of fees as a negative element to offerings as Older adults in the focus groups spoke
case study submissions (see Figure 4 for part of the case study review, with some about the importance of having access to
more details). Continuous (with no set end older adults within the focus groups stating offerings that supported both strength and
point) was a positive element highlighted this could be a barrier to attendance. balance, although balance was mentioned
about case studies as part of the review by However, this was not considered the most more frequently. This suggests that older
older adults, while time bound offerings important factor that discouraged adults are aware of and have a desire to
were a negative element highlighted. attendance to offerings. Overall, older adults improve these functions, and that offerings
Individuals who provided this feedback felt that where a fee had to be incurred it focusing on these aspects should continue
stated that they preferred continuous presented less of a barrier if there was to do so.
options because it allowed them more flexibility in the options for how to pay it
flexibility with attending and supported (e.g., to pay by session and/or in blocks or Other activities that offerings commonly
their physical activity participation over the as a membership fee). included were walking, social activities such
long term. Conversely, time bound offerings as tea/coffee catch-ups, and yoga / Pilates
(e.g. 6 to 12-weeks) were often not The case study submissions highlighted / Tai-Chi, (each in 48% of offerings). These
considered long enough to cause lasting that a vast range of activities are provided to activities indicate that offerings provide
health impacts or behaviour change. older adults who preferred to have a range older adults with an opportunity for social
interaction through group activities that
also support key areas of physical health.
Figure 4. Case Study Submissions - offering type breakdown
The opportunity for social interaction
through socialising was one of the six key
80%
themes identified and discussed in detail
70% later. Social interaction was not only
60% achieved through taking part in physical
50% activity offerings, but was also reported by
40% older adults as a key motivating factor
30% driving them to try out and re-attend these
offerings.
20%
10%
0%
Ongoing Digital offering Timebound Equipment Operator / Other
continuous (including app intervention supplier general service
programme or or wearable) (e.g. one lasting delivery (e.g.
intervention for a set something on
number of offer through a
weeks) membership
Offering category
13Frequency of offerings Figure 5. Case Study Submissions - delivery location.
Frequency of offerings emerged as a much 25%
more important area of accessibility for 19% 20%
20% 17%
older adults. Of the case study submissions
delivery once a week (33%) or more than 15% 12% 11%
twice a week (29%) are common delivery 8%
frequencies. Many offerings stated that 10%
their delivery frequency changed 4%
5% 1% 1%
depending on the specifics of the offering.
Offerings are delivered in a range of settings 0%
which is summarised in Figure 5. Online or
digital offerings may have become more
prevalent. Offerings were often delivered in
groups of 25 or less, but not 1 on 1 sessions
(50%) with some larger group delivery of
more than 100 people (12%) (Figure 6).
Digital delivery (15%) and general offering
through a facility which had no limit of site
capacity (13%) were also common amongst
the case studies received. This aligns with Figure 6. Case Study Submissions - average number of older adults taking part in offerings.
older adult preferences when it comes to Note – multiple options could be selected, results for each option are a percentage of the total number of case studies.
size of offering. In the focus groups, older
adults stated that they preferred smaller 45% 41%
class sizes (e.g., less than 20) as this class 40%
size fostered a greater sense of belonging
and safety. These smaller class sizes 35%
allowed the instructor to pay more attention 30%
to form and technique and provide 25%
personalised feedback. It was noted, 20%
however, that the need for this differs 15% 13%
10% 11%
depending on the type of class or offering. 9% 9%
10%
Having a smaller class size was perceived as 4% 3%
5% 2%
more important for classes that required 0%
higher attention to detail around technique 0%
(e.g., Pilates or weight training) and less
important for classes where risk of injury
was lower (e.g., Aquafit).
14Timing and booking options suggesting a certain number of spaces per use the equipment they wanted. In
class be reserved for individuals to book comparison, older adults who attended
Timing of offerings was also important to in-person or over the telephone. Reliance facilities for classes said it felt lonely and
older adults, specifically that a range of on online booking can present digital empty at off-peak times, with fewer
offerings were available on different days inequality barriers for some older adults; opportunities for social interaction and
and at different times throughout the week this is broadly defined as encompassing intergenerational mixing. Given the variety
so they could choose the timings that access, usage, skills, and self-perceptions in preference for timing, it was suggested
39
worked best for them. Preference around around use of digital technologies . Here, that determining the right split should be
day of the week or time of day was based on based on what older adults described, digital determined through customer feedback, so
the availability to book and attend offerings, inequality barriers refer specifically to as to suit customer needs.
and this determined when individuals access, usage and skill of using apps or
attended a facility. Many focus group websites to book on to bookable offerings Where I go there are very few
participants stated that greater scheduling and a lack of non-digital booking classes between midday and
flexibility was needed based on user needs, alternatives. 5pm, or 6pm. They tend to be in the morning
and that when an offering is oversubscribed or the evening, and not so much in terms of
more of that particular offering needs to be One class that I used to attend, if classes during the rest of the day, which is a
provided. Older adults stated that the you didn't stay up until midnight, bit restricting. Kiera, female
offerings that were most flexible, in terms of and book your slot for the following week,
their frequency, timing options and range of you wouldn't get in. And this is an issue for a Recommendation:
activities, and catered to their needs were lot of older people. I mean, I'm lucky, I do
the offerings that engaged in regular have access to the Internet, and I do know Make it easy and accessible
customer feedback and made changes how to use it, but there are a lot of older Utilise customer feedback to make
based on the feedback. This suggests that people who don't. Most people book online, necessary adaptations to scheduling that
continuous monitoring and evaluation of and that does restrict many [older] people ensures offerings are accessible to the
offerings is important in ensuring they from accessing these classes. Jack, male needs of all older adults. Accessibility can be
remain fit for purpose and suitable for the supported through:
needs of the target audience. A majority of pre-bookable offerings (e.g.,
group exercise classes) were described to • Ensuring a proportion of bookable
The attendance of older adults to specific take place at peak times (considered to be offerings are reserved for in-person and
offerings also depended on the accessibility mornings and evenings by the focus group telephone booking, in addition to online, to
of the booking systems. The ability to book participants) which was described by remove digital inequality barriers.
classes or activities in advance was participants as ‘limiting’. This however,
considered extremely valuable because it varied dependent on location. Older adults • Distributing popular offerings throughout
helped maintain a regular activity routine stated that fitness and leisure facilities could the day to support working and retired older
and enforced personal accountability to maximise how frequently older adults adults.
attend. Older adults praised online booking, attended offerings by making more
however noted that a fairer booking process available during off-peak times, such as in
which limited the number of classes the middle of the day (catering to retired
Recommendation:
someone could book in a day would help individuals), or on the weekends, instead of
Focus on strength
prevent popular classes being booked up by just the mornings and evenings. Older
Engage older adults in offerings that
people who then did not attend. Participants adults who attend facilities to use the gym
maintain and build strength as early as
also referenced that the booking process floor rather than sport facilities or classes,
possible to sustain strength and help
needed to be more accessible to older adults stated they preferred attending in off-peak
maintain independence.
who did not have access to technology, times because it was easier and quicker to
15Atmosphere Figure 7. Atmosphere sub-themes.
The atmosphere created by those who run Atmosphere
physical activity offerings influenced
whether an older adult would return, and
was a key theme throughout the focus
groups (Figure 7).
A sense of
A sense of welcome and comfort Belonging and
welcome and Facility upkeep
inclusion
comfort
Having a welcoming and inclusive
atmosphere was rated as a positive element
to offerings in the case study reviews. As centre or offering location also plays an My very local nearest Sports
part of the case study submissions, each important role. Older adults stated that it Centre is council run. And it
offering self-rated, on a scale of 0 to 10, how was important to be able to see individuals literally is about half a mile up a hill from me
much of an inclusive, comforting, and like themselves, for example in promotional and I would go there, except the only times
welcoming atmosphere they feel is created materials and on the gym floor, and I've been there, the paint is peeling off
for older adults using their offering. The specifically referred to only seeing ‘fit everywhere, the posters are skew-whiff
majority rated themselves as 8 or above out individuals in lycra’ as off putting or a and out of date, and it just has a general air
of 10 (88%). This suggests that those deterrent. This was not specific to age, but of dilapidation and neglect to it. And so I go
delivering offerings feel they are working to instead a desire to see ‘all shapes and sizes’ in there, and I asked, you know what, what
develop environments with atmospheres represented. they're doing and I, at the back of my mind,
that reflect the needs of older adults. At this I'm afraid I am thinking, I wonder how up to
stage however, we cannot say whether [Some older people are] date, the facilities are, you know, the gym
older adults would rate offerings in the same uncomfortable surrounded by facilities, the training machines, etc. when
way. What can be said is that when people in too much lycra and I do think that the rest of the facility looks so rundown. So
exploring this theme in more depth in the puts a lot of people off. So it's how you it does have a[n] impact. Sue, female
focus groups, a sense of feeling welcomed engender that sense of [everyone is
and comfortable in the offering welcome]. Camilla, female Recommendation:
environment was extremely important. The
older adults suggested that if no one Facility upkeep Create and build atmosphere
welcomed them or there was no rapport
with staff or other customers, they would Finally, atmosphere was also dependent on Offerings should look to build and maintain
find this off-putting and would be unlikely the upkeep of the facility which was specific a welcoming and inclusive atmosphere to
to return. Yet, if older adults felt welcomed to offerings that were run in a leisure centre, increase the likelihood of repeat customer
and known as individuals, this would operator site or studio. This included usage and build customer confidence.
encourage them to continue attending. The external and internal look (including Atmosphere and confidence can be built by:
importance of being ‘known’ as an promotional materials and general
individual was frequently stated by older maintenance), cleanliness, how up to date • Fostering a sense of community and
adults. Being ‘known’ came from staff and the machinery was and how quickly it was belonging among older adults attending
instructors taking the time to speak to and repaired when broken, the quality and offerings through building rapport between
connect with them, having their individual working condition of facilities (e.g., showers, the workforce and customers.
needs considered, and feeling like they were changing rooms) and safety. Upkeep,
a part of a community. particularly appearances, could outweigh • Maintaining high standards of safety
through keeping all facilities, equipment,
I think the biggest thing that would be off-putting is if you felt that there was no
and promotional materials up to date, clean
rapport with anyone. There's no greeting, there's no welcome... and conversely, the
and in good working condition.
biggest thing that draws me to our leisure centre is the feeling of we're all recognised as
individuals. So we're ... no one's lumped together as any type of exercise or any class or
gender or age group or, or fitness level or anything. We're all individuals. And that is what I
think would encourage more people to exercise if you're known as an individual and ... a
person... on your own fitness journey. John, male
location in terms of deciding what centre to
Belonging and inclusion attend. While this factor was not expressed
as frequently as factors of belonging and
A positive atmosphere can also be created feeling welcome, older adults did state that if
through a sense of belonging and inclusion. a facility looked like it was in disrepair and
This not only includes feeling part of a was not timely on its equipment and facility
community, but also the sense that maintenance (e.g., left machinery
everyone is welcome as they are, with their unrepaired for extended periods), it
individual fitness needs and abilities negatively impacted perceptions of the
recognised. While this atmosphere is offerings and desire to attend it. Therefore,
primarily dependent on the staff and while general maintenance, safety and
instructors, particularly when it comes to upkeep of facilities should be a standard of
catering to specific fitness needs, older all offerings, ensuring customer confidence
adults felt that the type of advertising, exists around this is equally as important to
promotion and representation within the prevent these negative perceptions.
16Socialising older adults who were retired noted the
importance of being able to attend an
One of the factors that encourages offering and meet people on a regular basis,
participation in physical activity offerings or which positively replaced the workplace
attendance to fitness and leisure facilities interaction they used to have. Social
was the opportunity for socialising and interactions were both reduced and missed
interaction with others. A number of case during the Covid-19 pandemic with many
study submissions included offerings with offerings not being delivered in their usual
social opportunities indicating that meeting face-to-face format. This experience
this particular need is already occurring and highlighted that for many participants a key
could be replicated or extended to improve aim and role of offerings should be to bring
social opportunities. However, this does not people together through socialising, and
reflect what the majority of case study that physical activity offerings could also
submissions feel their offering outcomes support mental health and bring back
are. As part of the case study submission, missed social interaction taken away
submissions were asked to rate eight through the Covid-19 pandemic. It was also
outcomes in order of importance. The most noted that messaging around the social
important outcomes were increasing opportunities included as part of offerings
physical activity levels (44% rating this would help make them more appealing.
first), increasing strength and balance (20% said to promote socialising and support
rating this second) and maintaining or The social aspect of any type of improvements in self-efficacy for physical
33
increasing personal wellbeing (e.g., activity is incredibly important. activity . Social support was discovered as
happiness/reducing anxiety; 24% rating Both for your enjoyment of doing it, and also a protective factor against risk of loneliness,
this third). Maintaining or increasing your mental health. I think getting out there even more so throughout the Covid-19
opportunities for social interaction and meeting with other people and doing pandemic, making opportunities for social
41
(reducing isolation; 24% rating this seventh) things with other people, just talking with interaction highly relevant . Therefore
and supporting Covid-19 rehabilitation (54% other people. One of the things that I think increasing, improving and maintaining
rating this eighth) were deemed the least many people have missed during COVID is opportunities for older adults to socialise
important outcomes related to the case social interaction with friends, family. So I and interact through exercise also offers an
studies submitted. think sport and activity can add opportunity for the fitness and leisure
enormously to that. Linda, female sector to improve membership attendance,
Although opportunities for social draw in new members and enhance
interaction were not seen as important Socialising seen as an integral part of member experience because of the link
outcomes within the submitted case offerings between regular physical activity,
40
studies, opportunities to socialise were socialising and perceptions of enjoyment .
frequently highlighted as positive elements Older adults stated that they felt it was
by older adults through the case study increasingly important to continue to Recommendation:
reviews. This was also a strong theme that interact and see others as they aged, and
emerged from the focus groups (Figure 8). that a gym environment was a great place Make it social
Offerings should look to maintain and
Figure 8. Socialising sub-themes. increase socialising opportunities for older
adults in order to support physical, mental
Socialising and social health, improve experience and
drive attendance.
Provides a Is integral to
Increases
sense of offerings, activities
enjoyment
camaraderie and in facilities
Socialising provides camaraderie and to do that. The sense of ‘camaraderie’ and
enjoyment ‘community’ was described as a strong
motivating factor for re-attending offerings,
Opportunities to socialise and interact with because seeing friends and interacting with
others, both with friends and younger others was something to look forward to
individuals, was a major factor that drove and made physical activity more enjoyable.
older adults to attend, and continue This supports previous research that
attending, offerings. For many attending, it suggests combining physical activity and
provided them with a large proportion of opportunities for socialising or social
their overall social interaction. This was interaction were positive ways to increase
40
particularly the case for older adults who activity levels 32 and maintain them . This
had limited interactions with others, such as also links to the data previously discussed
those living alone or retired. For example, around group activities, which have been
17Instructors I wouldn't ever get go back a
second time to a class that had a
Good instructors will lead you
forward and say, for the people
Instructors were a major influencing factor poor instructor. So they need to be very who are more advanced, they can do this.
in whether older adults enjoyed themselves, aware of their class, and have exercises that For the people who are not quite so active,
felt comfortable, welcome, safe, and could be modified for people. Shauna, they can they can stay to this level. And
motivated, and returned to physical activity female that's where a good instructor shows [their]
offerings. This was not an element initially merit, by adapting himself or herself to the
explored through the case studies, however, Instructor attention and feedback class that so that they can help everyone
it was discussed at length by older adults as Older adults wanted instructors who paid feel fulfilled at the end of that class. Sue,
part of the focus groups. The three areas in attention to their needs during an offering, female
which instructors made a difference was and on the gym floor, and provided
their level of technical and health feedback where appropriate which helped Instructor communication and
knowledge, the level of attention and them progress or improve. Older adults felt interpersonal skills
feedback they provided, and their that the best instructors were those who
communication and interpersonal skills monitored individuals in a class and Finally, communication and interpersonal
(Figure 9). Each of these were considered adjusted routines or form depending on skills were deemed essential in engaging all
equally as important. ability, mobility and technique. Older adults individuals, not just older adults, in offerings
and for repeat attendance. Communication
Figure 9. Instructors sub-themes. skills referred to an instructor’s ability to
communicate clear instructions around
Instructors how to perform exercises, emphasising
safety yet remaining motivational in nature.
Being motivational through conversation
was mentioned repeatedly by older adults
as the aspect of communication that made
Knowledge them want to re-attend offerings. If
Attention and Communication and instructors were perceived as
(technical skill
feedback provided interpersonal skills non-motivating, it was unlikely individuals
and health) would return. Interpersonal skills included
having the emotional intelligence to
recognise when individuals did not feel
comfortable or were at risk of injury and
Instructor knowledge (technical skill and frequently stated that these kinds of knowing how to act to make them feel
health) instructors were the ones who led the welcome, included and safe. This was often
offerings they continued to attend, and described by older adults to come from
Older adults were most drawn to classes would go back to when lockdown instructors who showed compassion and
where instructors were knowledgeable and restrictions eased. This is similar to the empathy towards different abilities and
had the technical skill to be able to lead and theme of atmosphere described above, and needs, alongside having the confidence to
offer safe and effective exercise options. In that the sense of being recognised as direct and lead safe and appropriate
addition to technical skill, it was important having individual needs increases the exercise.
that instructors knew how to adapt and feeling of a welcoming and inclusive
apply this skill on an individual basis, based atmosphere and desire to return. Adjusting In terms of instructors, I suppose
on ability and health condition. For example, form was particularly important in certain number one is technical /
one participant indicated it was extremely activity types that required more technique competence skills, and number two I would
important that an instructor, either as part and skill, like Pilates or weight lifting (e.g., say is empathy with the participants. So
of an offering (e.g., group exercise class) or Body Pump), and influenced how confident being able to adjust routines if somebody is
through supporting on the gym floor, knew older adults felt around the safety of the physically unable to do something. Claire,
how to adapt exercises to suit her mobility offering. Feeling safe and at reduced risk of female
level so it did not aggravate her arthritis, and injury was extremely important for older
she would not want to attend the offering or adults, and they felt instructors needed to Recommendation:
seek out that individual again if they were be aware of the ability changes that came
unable to do this. Providing personalised with ageing, even if they were not catering Prepare the workforce
adaptation to exercises, having knowledge activities by age. This extended to Ensure the workforce have the people skills
of how different health conditions impacted instructors on the gym floor, who were to deliver high quality offerings and can
ability and how to adapt exercises perceived as adding to these feelings of support older adult’s specific health and
appropriately was what participants called safety, confidence and atmosphere when activity needs.
‘inclusive knowledge’ and could influence they paid attention to those using the
attendance. facility and equipment and offered Training should contain:
personalised, goal-orientated help or • Specific modules that focus on building
feedback if needed. communication and interpersonal skills,
alongside applied practice, with individuals
I do think it's important that trainers understand the conditions that we're dealing
of all ages and abilities (including older
with, because they can tailor the exercises then to people's abilities. And I find
adults).
that they are definitely more understanding of, of the limitations that somebody has got. I
don't think I would want to be in a class with a trainer that didn't really understand that.
• Where possible the workforce working
Margaret, female
with older adults should be assessed as
competent against relevant standards for
working with older adults and those with
long term health conditions to enable them
to cater for individual health needs and
signpost to relevant support where
required.
18You can also read
