The Influence of Body Image on Exercise in the Elderly

1. The Influence of Body Image on Exercise in the Elderly Bindu Parchuri D.O. Geriatric Fellow NJISA

2. Questions • Is an elderly patient’s perception of aspects of body image such as attractiveness and functionality related to amount of exercise? • Do elderly who exercise feel more attractive and functional than those who do not?

3. Specific Aims • This study looked at whether there is a relationship between elderly patients’ perception of body image and physical activity • Aspects of body image such as attractiveness and functionality may be used as a positive enabler to help the elderly to initiate, continue and/or increase physical activity • Perhaps elderly patients who exercise more feel more attractive and more functional

4. Background • Obesity has been increasing in all age groups since the early 1960s • Overall, intentional weight loss has been associated with decreased mortality and morbidity • Exercise in later life has a positive effect on health • Improves cardiovascular, musculoskeletal, endocrine and psychological health • Associated with decreased mortality and age-related morbidity in older adults • “35% of individuals aged 65 and older reported engaging in insufficient physical activity and 28% reported being inactive.” (Wallace)

5. Why don’t the elderly exercise? • Barriers • perceived lack of benefit • lack of motivation • fears of incurring pain • feelings of being too old. • Positive enablers have been shown to be access to facilities and having a companion.

6. Motivation • Bahram, et al., looked at 120 men and women aged 25 to 65 • “active adults had [a] more positive body image than inactive adults.” • Hausenblas, et al., found that exercise improves body image, regardless of age • Tiggemann, et al., also found a positive correlation between exercise and self esteem • Younger men and women exercised more for attractiveness and enjoyment than older men and women

7. Motivation • Heinberg, et al., looked at body image and weight loss maintenance in elderly African Americans with hypertension • Found that subjective body image dissatisfaction was a positive influence on weight loss • Not many studies have focused on the elderly and their perception of their bodies

8. Motivation • Understanding factors that relate to exercise may be used in the future to influence the elderly to initiate, continue and/or increase physical activity

9. Body Image • This study examined different aspects of body image • Do subjects who exercise feel more attractive and functional than those that do not? • Appearance • Coordination • Overall Global Self Image

10. Methods • Survey/questionnaire completed prior to lecture • Community dwelling older adults – located through Nutrition Sites in Camden County • Demographics component of Questionnaire • PSDQ – Physical Self Description Questionnaire (Marsh) • Leisure Time Exercise Questionnaire (Godin)

11. Leisure Time Exercise Questionnaire By Godin • During a typical 7-Day period (a week), how many times on the average do you do the following kinds of exercise for more than 15 minutes during your free time (write on each line the appropriate number) • STRENUOUS EXERCISE (HEART BEATS RAPIDLY) • MODERATE EXERCISE (NOT EXHAUSTING) • MILD EXERCISE (MINIMAL EFFORT) • During a typical 7-Day period (a week), in your leisure time, how often do you engage in any regular activity long enough to work up a sweat (heart beats rapidly)?

12. Participants • Recruited participants from 4 Nutrition Sites in Camden County • Asked about 200 people to participate • Obtained 80 completed surveys • Participants ranged in age from 70 to 96 and included both men and women

13. Results • The participants ranged in age from 70 to 96 with the mean age being 81.3 (SD 6.1) • 75% (60) were female • 70% (54) were Caucasian; 27.3% (21) were African American; and 2.6% (2) identified themselves as other. • A majority (55.7%) responded that they did not discuss with their doctor increasing their physical activity.

14. Results • The subjects used 0 to 13 medications with the mean of 4.8. • 80% stated that they were not disabled, 17% of participants considered themselves obese • 88% of total participants lived in a single family home or an apartment • 14 % lived with a spouse; 36 % lived with a family member; and 49% lived alone

15. The Three Groups • The three groups were divided according to recommendations based on current CDC guidelines for exercise in adults and on recommendations from Dr. Godin. • The formula used was (Strenuous Ex x 9)+(Moderate Ex x 5)+(Mild Ex x 3) • Minimal – less than 23 • Moderate – 24 to 50 • Strenuous – over 50

16. PSDQ Scores by Exercise Group

17. Results • When scores were examined using Kruskal-Wallis, differences between groups were not significant (Appearance, p =.446; Coordination, p = .279; Global Score, p = .138) • Among the strenuous exercisers, none considered themselves obese or disabled; 23% of moderate and minimal exercisers considered themselves obese or disabled

18. Conclusions • This study explored the relationship between appearance, functionality, body image and total exercise • There were no statistically significant relationships between amount of exercise and measures of perceived body image • Of those that did strenuous exercise, 100% did not consider themselves to be disabled or obese

19. Problems • Not enough participants • There were not enough participants who exercised strenuously • Some difficulty having participants complete entire questionnaire • “Too Long” • Some confusion on how too complete the PSDQ scale • A few agreed to complete with assistance

20. References • Bahram, A and Shafizadeh. A Comparative and Correlation Study of Body Image in Active and Inactive Adults and with Body Composition and Somatotype. Journal of Applied Sciences (6): 2456-2460. 2006 • Chau, D, Cho, L, Jani, P et al Individualizing recommendations for weight management in the elderlyCuur Opin Clin Nutr Metab Care (11) p 27-31 2008 • Conn, V. Older Women’s Beliefs about Physical ActivityPublic Health Nursing (15) p370-378 1998 Oct • Degerance, J et al barriers to and Benefits of Leisure Time Physical Activity in the Elderly: Differences across cultures.JAGS (51) p 863-868, 2003 • Furnham, A, Badmin, N and Sneade, I. Body Image Dissatisfaction: Gender Differences in Eating Attitudes, Self Esteem, and Reasons for Exercise. Journal of Psychology, 136(6) p581-596, 2002 • Marsh, H et al. PSDQ Instrument Self Research Center 1999 • Marsh, H et al. Structure of Physical Self-Concept: Elite Athletes and Physical Education Students Journal of Educational Psychology 1997 vol 89 p 369-380 • Marsh, H. Physical Self Description Questionaire: Stability and Discriminant Validity Research Quarterly for exercise and Sport 1996 Vol 67 p 249-264 • Heinberg, L et al Body Image and weight loss Maintenance in Elderly African American Hypertensives American Journal of Health Behavior (24) p 163 – 174, 2000 May • Hui, E, Rubenstein, L. Promoting Physical Activity and exercise in Older AdultsJAMDA(7) p310-314 2006 June • Kennedy, R. et al Obesity in the Elderly: who should we be treating, and why, and how?Cuur Opin Clin Nutr Metab Care (7) p 3-9 2004 • McAuley, E. Blissmer, B. Katular, J, et al. Physical Activity, Self Esteem, and Self-Efficacy Relationships in Older Adults: A randomized Controlled Trial. Annals of Behavioral Medicine (22) p 131-139 2000 Nov • Neid,R Promoting and Prescribing Exercise in the ElderlyAmerican Family Physican Feb 2002 Vol 65,

21. References • Wallace, K et al. Motivation In Later Life Topics in Geriatric Rehabilitation Vol 21 p 95-106 • Cooper K. et al Health Barriers to Walking for Exercise in Elderly Primary Care.Geriatric Nursing 2001 vol 22 , 5 • Belza, B et al. Older Adult Perspectives on Physical Activity and Exercise: Vioces from Multiple CulturesPreventing Chronic Disease Vol 1 Oct 2004 • Tiggemann, M et al. The Effect of Exercise on Body Satisfaction and Self Esteem as a Function of Gender and Age Sex Roles Vol 43 2000 • Tiggemann, M Body image across the adult life span: stability and changeBody Image Vol 1 2004 p 29-41 • Hausenblas H. et alExercise and body image: A meta-analysisPsychology & Health, 1476-8321, Volume 21, Issue 1, 2006, Pages 33 – 47 • Godin, G et al Assessment of Leisure Time Exercise Behavior by Self-Report: A concurrent Validity Study Canadian Journal of Public Health Vol 77 p 359-362 • Peart, N et al. The Physical Self Description Questionnaire: furthering research linking physical self concept, physical activity and physical educationhttps://www.aare.edu.au/05pap/pea05307.pdf • Clark, D. Identifying Psychological, Physiological and Environmental Barriers and Facilitators to Exercise among Older Low Income Adults Journal of Clinical Geropsuchology Vol 5 1999 • CDC exercise guidelines, www.cdc.gov/physicalactivity/everyone/guidelines, accessed August 2009.