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

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?

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

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)

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.

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

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

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

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

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)

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)?

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

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.

Results The subjects used 0 to 13 medications with the mean of % 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

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

PSDQ Scores by Exercise Group GroupAppearanceCoordinationGlobal MeanSt DevMeanSt DevMeanSt Dev 1 (N=45) (N=20) (N=10)

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

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

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

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): Chau, D, Cho, L, Jani, P et al Individualizing recommendations for weight management in the elderly Cuur Opin Clin Nutr Metab Care (11) p Conn, V. Older Women’s Beliefs about Physical Activity Public Health Nursing (15) p Oct Degerance, J et al barriers to and Benefits of Leisure Time Physical Activity in the Elderly: Differences across cultures. JAGS (51) p , 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) p , 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 Marsh, H. Physical Self Description Questionaire: Stability and Discriminant Validity Research Quarterly for exercise and Sport 1996 Vol 67 p 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 Adults JAMDA(7) p 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 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 Nov Neid,R Promoting and Prescribing Exercise in the Elderly American Family Physican Feb 2002 Vol 65,

References Wallace, K et al. Motivation In Later Life Topics in Geriatric Rehabilitation Vol 21 p 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 Cultures Preventing 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 Tiggemann, M Body image across the adult life span: stability and change Body Image Vol p Hausenblas H. et al Exercise and body image: A meta-analysis Psychology & Health, , Volume 21, Issue 1, 2006, Pages 33 – 47Exercise and body image: A meta-analysis 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 Peart, N et al. The Physical Self Description Questionnaire: furthering research linking physical self concept, physical activity and physical education Clark, D. Identifying Psychological, Physiological and Environmental Barriers and Facilitators to Exercise among Older Low Income Adults Journal of Clinical Geropsuchology Vol CDC exercise guidelines, accessed August