Determinants of physical activity among middle aged and elderly

INTRODUCTION

Indonesia facing a double burden of malnutrition, where the prevalence of under-nutrition is still high and the prevalence of over-nutrition tend to increase. This situation may increase the risk of non-communicable diseases due to metabolic disorders, such as diabetes, hypertension and stroke. The increase in risk factors for non-communicable diseases (NCDs) is influenced, among others, by the low understanding and awareness of the public to implement a balanced nutritious diet and carry out physical activity.¹ The results of basic health research (Riset Kesehatan Dasar, Riskesdas) in 2013 showed that as many as 26.1 percent of the population was classified as living a sedentary ilfe (lack of physical activity). Therefore, in 2017, Indonesia launched the healthy living community movement (Gerakan Masyarakat Hidup Sehat, GERMAS) where one of the goals was to increase physical activity. GERMAS within the scope of increasing physical activity are socialization, the involvement of leaders of school institutions and companies, as well as facilitation of infrastructure. COVID-19 is still stalking all of us, so changes in hygiene and healthy living behavior are needed. The recommended physical activity in GERMAS activities is to do physical activity 30 minutes per day, in the form of daily activities, physical exercise, and sports.² After GERMAS activities were carried out, physical activity measurements have been carried out again in 2018.

Riskesdas 2018 reported physical activity using questions modified global physical activity questionnaire (GPAQ). The collected physical activity behavior includes strenuous and moderate physical activity on daily activities (combined at work or at home, leisure time, and transportation) in days per week and in minutes per day. High physical activity is physical activity performed for >3 days per week and >1500 MET minutes per week (MET value of minutes of heavy physical activity=8). Moderate physical activity is physical activity being performed for >5 days a week with an average length of such activity >150 minutes a week (or >30 minutes per day). Riskesdas 2018 reported that in the population aged 45-59 years, there were 21.9-25.8% that live sedentary lifestyle (lacked physical activity). In the age group above 60 years, only 31.4-47.9% did less physical activity.³ Thus, there has been no significant increase in the level of physical activity, including in the older. Individuals among middle aged and elderly group were a concern in the study, as they were experiencing health challenges. In older, there has been an accumulation of processes of degeneration of body tissues, resulting in an increased risk of health problems and a decrease in the quality of life. Several studies have been conducted to look for factors that influence the involvement of individuals in physical activity, with the result that the determinants that influence are, among others, gender, economic ability, and health factors (e.g. comorbidities), but these determinants differ from country to country.^4-6 The reluctance of individuals of older in Indonesia to engage in physical activity must be considered and we need to find out the cause of physical encouragement, in order to be able to take relevant promotional measures to encourage physical activity. This study was conducted to look for these factors, in this research, we limit it to DKI Jakarta as an urban area. The restrictions were made due to differences in urban and rural lifestyles.

METHODS

In order to obtain determinants related to physical activity among middle aged and elderly, this study used cross-sectional design. The collection of interview data in person or by telephone was carried out by enumerators who had followed the equalization of the perception of the contents of the questionnaire from the researcher. The population are 2.904.056 with aged 45 years and over, live in DKI Jakarta, the participants of this study are 199 among middle aged and elderly. Respondent’ answers recorded using an online questionnaire (g-form) prepared by the researcher with the data collection time January-June 2022. Determinant variables include gender, age, occupation, comorbidities, height, and weight which the enumerator immediately asked the respondent. Physical activity is obtained through interviews about physical activity for the past 7 days which include strenuous physical activity, moderate physical activity, walking or cycling activities of at least 10 minutes, recreational or strenuous sports activities, and moderate sports activities. High physical activity is an activity that requires more energy characterized by shortness of breath and a elevated heartbeat rhythm. The questionnaire used is the GPAQ (WHO, 2012) which has been used in routine health surveys in Indonesia. The end result of physical activity is categorized into heavy, moderate, and low. Data analysis used IBM 21 SPSS with frequency descriptive data and looked at "r" values for correlation.^7-16

RESULTS

Total 199 participant join this study; it was found that the most participant were women 58% with an average age of 63 years where the lowest age was 45 years and the highest was 91 years. The characteristics of the participant may be seen in (Table 1).

Among middle aged and elderly tends to have comorbidities, from the most comorbid research data is found in a mother who is 55-year-old who has 7 comorbidities. Joint disease (65) and hypertension (63) are common diseases owned by participant. The results of the Kolmogorov-Smirnov normality test from this study variable were obtained non normally distributed with p=0.000<0.05. The research variables used categorical data with more than 2 groups so that gamma tests were used to see the correlation between variables.

Meaningful relationships determinants of physical activity are jobs with fairly strong relationships and positive relationship directions, followed by comorbid determinants with fairly strong relationships and positive relationships, and BMI with fairly strong relationships and negative relationships. Determinants that were not related to physical activity in this study were type of playfulness and age (Table 3).

DISCUSSION

The number of participants who did not carry out physical activity was 15%, lower than research in 2013 and 2018, without any meaningful difference between the gender and age of the respondents.^1,3

The prevalence of mild fats is higher than the national data in 2018 which amounted to 13.6%, although heavy fats were lower than the national data in 2018 which amounted to 21.8%.³ Different with a study conducted by Weeke 2021, in which at the age of 19-57 years physical activity has a weak negative relationship with BMI.⁸ It may happen as on above 45-year-old people, there are slowing metabolism causing physical activity to have a greater effect than at the age of under 45 years. After the age of 20-year-old, there is a 10% decrease in the speed of food metabolism for every decade. When it reaches the age of 50 years, there is already a 30% decrease in metabolic ability and a decrease in muscle mass (sarcopenia).⁹ Thus, physical activity must be carried out to help metabolic processes and maintain muscle function. Interestingly obtained from the results of this study, that there is a positive correlation in adult individuals with comorbidities indicating that individuals are encouraged to engage in physical activity because health problems have occurred. With this fact, it can be presumed that adult individuals are actually aware that regular physical activity can prevent chronic diseases and improve the quality of health but are reluctant to do so until they are forced to. For this reason, increasing the frequency of community services through monthly physical examinations (blood pressure, blood sugar, cholesterol and uric acid) can be upgraded, not only to individuals over 60 years old, but starting at the age of 45 years.⁴ This is necessary because hypertension, diabetes, cholesterol and hyperuricemia in most individuals are asymptomatic until they are already chronic.^10-12 The role of health workers to promote physical activity as a profession that is still trusted by the public is also very necessary, promotion by health workers is supported by a good perception of physical activity^..¹³ There is a positive correlation between individuals who are still employee and not, indicating that after entering retirement, as well as in individuals who are activities at home less active than working individuals. This means that the encouragement of physical activity in the household environment must be increased with a minimum limit of at least 150-300 minutes of moderate intensity throughout the week, or 75-150 minutes with strong intensity throughout the week, or a combination of moderate and strong intensity throughout the week. One of the important ones is also the understanding that the minimum limit of 150 minutes of activity throughout the week for adult individuals does not have to be done at one time, but rather divided through several sessions. In one day, it can be done 30 minutes divided into three sessions. A session can include 10 minutes of activity, and the type of activity performed varies. The activities chosen can be daily activities, including shopping to stalls, going to worship places, sweeping, cleaning beds, mopping, and washing dishes.¹⁴ Outside the home environment, it can be done through increasing the distance of vehicle parking, selecting walking lanes through pedestrian routes, or increasing visits to inclusive recreational parks for families (e.g., garden park in village).

Limitations

Interviews conducted over the phone can cause the understanding of the questions performed by the enumerator not to be conveyed correctly.

CONCLUSION

Physical activity in older is quite strongly related to work and non-work, having comorbid amounts, and body mass index. In general, among middle aged and elderly have comorbid hypertension and joint diseases.

ACKNOWLEDGEMENTS

Authors would like to thank the Universitas Kristen Indonesia which supports research funds and to research assistants (enumerators) who are willing to assist researchers in interviewing respondents.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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