The purpose of this study was to evaluate different psychosociological variables of behavior change related to PA in frail and prefrail elderly over 65 years. More specifically, it was hypothesized that advanced SoC (action or maintenance) for PA would be related to greater scores in SE, DB, PBn, OE, family and friend SS and lower scores in PBrr, than those in lower stages.
Our study is the first which has analyzed the SoC for PA in frail and pre-frail elderly over 65 years. The results showed that DB score increased across to the SoC. The same trend has been observed in other studies with elderly (19–21). Moreover, the participants in AM stages, perceived significantly more benefits to be physically active than those in PC and Pp stages, these results support previous research in elderly people in which at initial SoC perceived lower benefits compared to more advanced stages (19–22). However, the literature in healthy elderly has also revealed some contrary results where they did not find significant differences between the PBn according to the SoC (18, 23). On the other hand, our study has shown a decrease in the PBrr to PA score in the advanced SoC (AM) as already seen in the literature of healthy elderly people (18, 19, 21, 23). The study of Kosma & Cardinal (2016) (23) showed that self-PBrr contributed to explain only 11% of the variance in SoC. However, in our data, no significant differences between PBrr and SoC were found. Similar results than us were found in other studies (19, 22). This outcome could be due to the fact that PBrr to PA in frail older people could be specific and differ from those already outlined in healthy elderly. Therefore, it seems necessary to research in depth PBrr to PA in frail and prefrail elderly people. This need was revealed by Ellis et al., (2007) (24) when they studied this same association in elderly people with physical disabilities. Finally, we found a significant relationship between the PBn to be physically active with the OE and the SoC which confirms the SoC appear to be applicable and adequate for frailty elderly population.
In relation to SE, we found significant differences among SE score at the different SoC, observing an incremental trend as we progress in the SoC, which corroborates the data supported by the scientific literature for healthy elderly (19–23, 25). The same incremental trend was observed but without finding significant differences in other study (18).Our data supports a direct significant relationship among grouped SoC with SE score, OE, DB score and PBn, suggesting that as the ratings on these variables increase, a progress towards a more active SoC and vice-versa can be observed. Different studies in elderly people have determined SE as one of the predictors of SoC (21, 23), practice of PA (19, 20, 23, 25) and the risk of falls (23), however, our results provide novel evidences in frail and pre-frail elderly, suggesting that psychological determinants are important also in vulnerable elders to get enroll in PA or exercise programs.
Social support is one of the determining factors in the initiation and maintenance of PA in older people (4). Within our study, we have been able to identify that the most advanced SoC were significantly associated with higher family and friends-related SS scores compared to the initial stages. Studies have shown how SS influences SoC (26). In our study, family SS significantly increased from early SoC to later ones. Recent studies show that a greater self-perception of family SS is related to higher PA levels and meeting PA guidelines (27). Moreover, there is also evidence that suggests that friends SS is inversely associated with frailty (28). However, no significant differences were found for friends-related SS and SoC for PA in our study. We need to take into account, that frail elderly people may have a reduced group of friends, which may be not be accessible for them all the time. Hence, some research in healthy elderly people has supported the same non relationship (19).
As hypothesized, our results showed a significant progressive increase in the OE score according to the SoC. This provides evidence of the OE plays a very important role in the initiation and maintenance of PA in the frail elderly group, as it has already been manifested in healthy elderly people (4).
Our findings support the use of the TTM and SoC for PA in frail and pre-frail elderly people. In fact, the advanced SoC (action or maintenance) obtain better results in each psychosociological variable of behavior change with respect to those participants at initial SoC (precontemplation and contemplation) confirming that the structure of the behaviour change process appears to be the same as in other populations. Frail and prefrail individuals move from being unaware or unwilling to practice PA to considering the possibility of change (i.e. be physically active), then to becoming determined and prepared to make the change, and finally to taking action and sustaining or maintaining that change over time (i.e. adopt an active lifestyle).
Currently, the scientific literature on PA-related behavior change in frailty elderly is scarce. This study expands the knowledge in this science field, identifying the application of psychosocial variables of behavior change across grouped SoC in frail and prefrail elderly. Placing people into a stage of change helps to improve understanding and predicting PA behavior. This information is important for researchers, health professionals and health promotors as it will be useful for the development of future tailored PA interventions, based in these variables of behavior change and, finally, to promote an increase of PA levels.
This study has several limitations. Firstly, it was a observational cross-sectional study in which the more than half of participants were in action or maintenance stages (64.1%), a grouped stages approach was used in the statistical analysis, due to the low representativeness of individuals in the pre-contemplation and contemplation stages, the same groupings were made in elderly with pathology (18). Secondly, the sample size was small and it was composed of institutionalized and non-institutionalized frailty elderly. Finally, no relationship was found between PBrr and SoC, this may indicate that this population presents specific barriers that limit their practice of PA, independently of the PBrr by healthy elderly people or those with other pathologies, therefore, future researches are needed whose have more equitable samples, distributed in a similar way between each of the SoC and longitudinal designs to study these constructs in a more specific way, using scales with greater sensitivity that help to identify more effectively the possible perceived influences by frailty elderly people and that limit their practice of PA.