Factors Influencing Physical Activity among Older Women with Type 2 Diabetes

Purpose: With the recent increase in the number of people aged 65 years and over in South Korea, the prevalence of chronic diseases and, hence, related medical costs have rapidly increased.¹Diabetes is one of the most prevalent chronic diseases among older adults. Approximately 20% of older women aged over 65 years were found to be diagnosed with diabetes in 2013 (Statistics Korea, 2013), and many older women with diabetes were determined to have uncontrolled diabetes. Since adherence to self-management behaviors such as physical activity is crucial to control blood glucose levels and to prevent diabetes-related complications in older women(Ministry of Health and Welfare, Korean Centers for Disease Control & Prevention, 2013), health care providers have focused on enhancing diabetes self-management behaviors, in particular, physical activity in older women. That is because the levels of physical activity in older Korean women are relatively low (Statistics Korea, 2013). The purpose of this study was to identify factors influencing levels of physical activity in older women aged over 65 with type 2 diabetes in South Korea.

Methods: A total of 118 older women, who (a) were 65 years or older; (b) had been diagnosed with type 2 diabetes; (c) were taking medications to control glucose levels; and (d) visited community welfare centers, were recruited for the study. To collect data, multiple instruments related to physical activity of older adults including the Self-efficacy for Exercise Questionnaire (Resnick & Jenkins, 2000), the Theory of Planned Behavior Questionnaire (Francis et al., 2004) for social normative beliefs, attitudes toward physical activity, intention to participate in physical activity, the Question on Past Behavior (Hagger, Chatzisarantis, & Biddle, 2001) for experience, and the Korean version of the Physical Activity Scale for the Elderly (Choe, Kim, Jeon, & Chae, 2010) for level of physical activity were used. In addition, six questions on age, education level, comorbidity, perceived health status, duration of diabetes, and current treatments received (oral hypoglycemic agents, insulin) were used to collect background information on the participants. The data were analyzed using descriptive statistics including mean, standard deviations and percentage, and inferential statistics including Pearson's correlation analyses and hierarchical multiple regression analyses.

Results: The mean age of the participants was 76.2 (SD=6.1) years, and the highest level of education in about 60% of the older women was middle school or less. Approximately 64% of the older women had one or more comorbidities such as hypertension, arthritis or depression, and 45% perceived that they were healthy. Regarding diabetes-related characteristics, the mean duration of diabetes was 10.1 (SD=9.8) years, and about 98% of the participants took oral hypoglycemic agents for glycemic control. The mean total physical activity score in older women was 86.0 and ranged from zero to 320.0. Specifically, the mean physical activity score for leisure-time, household-related, and job-related physical activities was 18.2, 59.5, and 8.3, respectively. The self-efficacy score had a statistically significant positive correlation with the physical activity scores (r=.21, p<.05). In addition, self-efficacy was a significant predictor of physical activity in older South Korean women with type 2 diabetes (β=.20, p<.05). These variables accounted for 6% of the total variances in physical activity in the regression model.

Discussion: The study concluded that the level of physical activity was relatively low compared with the results from a previous study (Stiggelbout, Hopman-Rock, Crone, Lechner, & van Mechelen, 2006). This might be due to the fact that the score of job-related physical activity in this study was lower than the one in the previous study (Stiggelbout et al., 2006). Furthermore, the findings of the study revealed the important role of self-efficacy in physical activity in older Korean women with type 2 diabetes. Therefore, health care professionals, including nurses, should encourage older women to participate in regular physical activity. To this, health care professionals, who are interested in developing diabetes education programs for increasing physical activity levels among older South Korean women with type 2 diabetes, should consider the important role of self-efficacy. In addition, health care providers should take into account the strategies for enhancing self-efficacy for physical activity. Finally, the findings of this study need to be tested in older Asian women with type 2 diabetes in other countries through international collaborative studies. It is because older Asian women tend to have low levels of physical activity and high levels of vulnerability in health care system not only in South Korea but also in other countries.

Keywords: Physical Activity, Type 2 diabetes, Older women

References

Choe, M.A., Kim, J., Jeon, M., & Chae, Y.R. (2010). Evaluation of the Korean version of physical activity scale for the elderly (K-PASE). Korean Journal of Women Health Nursing, 16(1), 47-59.

Francis, J.J., Eccles, M.P., Johnston, M., Walker, A., Grimshaw, J., Foy, R., et al. (2004). Constructing questionnaires based on the theory of planned behavior.Newcastle UK: Center for Health Services Research University of Newcastle.

Hagger, M.S., Chatzisarantis, N., & Biddle, S.J. (2001). The influence of self-efficacy and past behaviour on the physical activity intention of young people. Journal of Sports Sciences, 19(9), 711-725.

Ministry of Health and Welfare, Korean Centers for Disease Control & Prevention (2013). Korea Health Statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANES V-3). Seoul: Korea Centers for Disease Control and Prevention

Resnick, B., & Jenkins, L. S. (2000). Testing reliability and validity of the self-efficacy for exercise scale. Nursing Research, 49(3), 154-159.

Statistics Korea (2013). Statistics on the aged 2014. Retrieved from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=308688.

Stiggelbout, M., Hopman-Rock, M., Crone, M., Lechner, L., & van Mechelen, W. (2006). Predicting older adults' maintenance in exercise participation using an integrated social psychological model. Health Education Research, 21(1), 1-14.