Abstract
[Purpose]
Regular exercise is crucial for preventing frailty and functional decline in older adults participation remains low, especially at advanced ages. Although barriers to exercise in later life have been identified, differences across age groups within older populations remain understudied. This study examined barriers to exercise participation across age categories among adults aged 65 years or older.
[Methods]
We conducted a cross-sectional survey of 312 adults aged ≥ 65 years in South Korea (mean age, 80.47 ± 6.80 years). Participants were categorized into four age groups (65-75, 76-80, 81-85, and ≥ 86 years). Barriers to exercise participation were assessed across five domains: economic constraints, psychological or emotional constraints, information seeking skills, environmental or physical constraints, and program-related aspects or personal concerns. Chi-square tests and post-hoc analysis were used to identify differences in reported barriers across age groups.
[Results]
Significant age-group differences were observed in psychological or emotional constraints, information seeking skills, and program-related aspects or personal concerns. These barriers did not significantly differ between the 65-75 and 76-80 years age groups; however, they were reported more frequently among participants aged ≥ 81 years, with the highest reporting observed among those aged ≥ 85 years.[Conclusions] Barriers to exercise participation vary qualitatively across age strata and become particularly pronounced after age 81. These findings underscore the limitations of considering older adults as a homogeneous group and highlight the need for age-sensitive, integrated intervention strategies to promote exercise participation among the oldest-old.
Keywords: exercise barriers, physical activity, older adults, oldest-old, digital literacy
INTRODUCTION
Health problems among older adults become increasingly complex and pronounced with increasing age. Chronological age, frailty, disability, institutionalization, and multimorbidity have been consistently identified as major risk factors for adverse health outcomes in later life [1,2]. With increasing age, multimorbidity and frailty exert independent and interactive effects that heighten health vulnerability, thereby elevating the risk of disease progression, functional decline, mortality, hospitalization, and restricted daily living [3,4].
The accumulation of age-related health risks may substantially diminish the quality of life of older adults and increase healthcare burden. This underscores the need to identify strategies that mitigate health deterioration and delay functional decline. Regular exercise or physical activity reduces the risk of frailty and functional impairment [5]. Moreover, these beneficial effects are present even among the oldest-old. In one study, home-based exercise programs attenuated frailty risk among individuals aged ≥ 80 years [6]. Additionally, several longitudinal studies have reported that physically active older adults exhibit lower mortality rates and a greater likelihood of functional independence than inactive older adults [7].
Despite the well-established benefits of exercise, participation remains limited among older adults and is often constrained by multiple barriers. Physical functional decline, chronic conditions, pain, fear of falling, environmental constraints, and insufficient social support have been widely identified as factors hindering exercise in later life [8,9]. Moreover, barriers to exercise vary according to the level of engagement in physical activity, suggesting substantial heterogeneity in the older adult population [10]. These findings imply that exercise barriers do not simply accumulate as age advances; rather, their nature and effects may change over time and differ according to existing lifestyles and activity levels.
Therefore, older adults should not be considered a homogeneous group. Poor health remains the most prominent barrier among adults aged ≥ 80 years, whereas social and motivational factors play a substantial role among younger older adults [11]. Such evidence indicates that the patterns and relative importance of exercise barriers vary across age strata.
Nevertheless, most previous studies analyzed outcomes among older adults as a single group, without examining potential differences across age levels. In the context of the exceptionally rapid population aging in South Korea [12], research that explicitly considers age-specific characteristics is needed to develop effective health promotion strategies for older populations.
In addition to conventional physical and environmental constraints, recent research has highlighted the role of digital factors in shaping the exercise behaviors of older adults. With the expansion of digital technologies, information seeking skills and digital literacy have emerged as salient determinants of exercise participation and maintenance [13]. As access to exercise programs, health information, and community-based exercise resources are increasingly provided through online platforms and mobile-based services, the ability to search for, understand, and utilize relevant information plays a critical role in sustained exercise participation [14]. However, older individuals experience difficulty using digital technologies [15], which may limit their awareness of available exercise opportunities and restrict participation. Moreover, the expansion of non-face-to-face exercise programs and online health information delivery after COVID-19 has amplified the importance of digital competency and positioned its lack as a salient exercise barrier among older adults [16].
Considering prior findings and the rapid population aging in South Korea, it is important to understand age-specific exercise barriers among older adults. Therefore, this study aimed to examine age-specific exercise barriers among older adults by stratifying them according to age groups. With this aim, the study sought to provide foundational data for the development of targeted intervention strategies that promote healthy aging.
METHODS
Participants
This study targeted individuals aged ≥ 65 years who demonstrated sufficient cognitive ability to complete a survey and had no orthopedic or other medical conditions that could limit exercise participation. The participants were recruited from community welfare and senior centers in Seoul and Chungname, South Korea, as well as from community-dwelling individuals living in the same area who were referred by center members. A total of 312 participants were included in the study, with a mean age of 80.47 ± 6.80 years.
Participants were stratified into four age groups (65-75, 76-80, 81-85, and ≥ 86 years) to reflect the heterogeneity of aging and progressive functional decline associated with advancing age. Gerontological research commonly distinguishes subgroups within the older population, such as the young-old (65-74 years), old-old (75-84 years), and oldest-old (≥ 85 years), acknowledging that biological, functional, and social changes do not occur uniformly across later life [17,18]. Furthermore, functional limitations, frailty, and health vulnerabilities tend to accelerate in the later stages of aging, particularly after approximately 80 years of age [19]. Accordingly, further stratification of older adults in this study enabled a more detailed examination of age-related differences in barriers to exercise participation.
Data collection
Before data collection, standardized training was provided to three research assistants to promote consistency and ensure acceptable inter-rater reliability. The research team visited the participating centers to directly administer and distribute the questionnaires to the participants. The questionnaires were completed through self-reporting, and the research team remained available to offer explanations or assistance when necessary. Completed questionnaires were retrieved immediately upon completion.
Written informed consent was obtained from all participants prior to their inclusion in the study. The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Sangmyung University, Seoul, Republic of Korea (IRB No. ex-2024-039).
Survey instrument
A questionnaire was utilized to determine barriers to exercise among older adults. The questionnaire comprised 20 items across five domains: economic constraints (one item), psychological or emotional constraints (six items), information seeking skills (three items), environmental or physical constraints (seven items), and program-related aspects or personal concerns (three items). These items were included based on previously published literature [20-22]. All items were rated on a 5-point Likert scale. Internal consistency reliability of the questionnaire was evaluated using Cronbach’s alpha coefficient, which demonstrated satisfactory reliability (α = 0.837). To analyze responses measured on a 5-point Likert scale, responses of “strongly disagree” and “disagree” were categorized as “no,” whereas “neutral,” “agree,” and “strongly agree” were categorized as “yes.” Based on this reclassification, the presence and absence of exercise barriers were compared in the analysis.
Data analysis
Chi-square tests were performed to determine age-group differences in the reported exercise barriers, followed by post-hoc analyses using adjusted residuals with Bonferroni correction for items showing significant results. Further analyses were conducted to examine age-group differences in factors that showed significant differences.
These tests were performed using SPSS and Amos 31.0 (IBM Corp., Armonk, NY, USA), with statistical significance set at α = 0.05.
RESULTS
Table 1 presents the age-group differences in reported exercise barriers among older adults. Significant differences across age groups were observed for several items, particularly those related to psychological or emotional constraints, information seeking skills, and exercise program-related aspects or personal concerns.
Table 1.
Age-group differences in exercise barriers
| Age category |
||||||||
|---|---|---|---|---|---|---|---|---|
| 65–75 | 76–80 | 81–85 | 86+ | Total | P-value | |||
| N (%) | N (%) | N (%) | N (%) | |||||
| Sex | Female | 48 (20.1) | 47 (19.7) | 80 (33.5) | 64 (26.8) | 239 | 0.125 | |
| Male | 23 (31.5) | 11 (15.1) | 26 (35.6) | 13 (17.8) | 73 | |||
| Reasons for lack of exercise | ||||||||
| Economic constraints | Cost-related concern | No | 47 (22.8) | 37 (18) | 67 (32.5) | 55 (26.7) | 206 | 0.681 |
| Yes | 24 (22.6) | 21 (19.8) | 39 (36.8) | 22 (20.8) | 106 | |||
| Psychological or emotional constraints | No interest or dislike in exercising | No | 39 (25.5) | 28 (18.3) | 56 (36.6) | 30 (19.6) | 153 | 0.192 |
| Yes | 32 (20.1) | 30 (18.9) | 50 (31.4) | 47 (29.6) | 159 | |||
| Dislike interacting with people or moving my body in the same space as others | No | 49 (20.9) | 47 (20.0) | 82 (34.9) | 57 (24.3) | 235 | 0.416 | |
| Yes | 22 (28.6) | 11 (14.3) | 24 (31.2) | 20 (26.0) | 77 | |||
| Absence of someone to provide emotional support and encouragement | No | 46 (27.1) | 32 (18.8) | 55 (32.4) | 37 (21.8) | 170 | 0.201 | |
| Yes | 25 (17.6) | 26 (18.3) | 51 (35.9) | 40 (28.2) | 142 | |||
| Absence of someone to exercise with | No | 38 (28.8) | 31 (23.5) | 43 (32.6) | 20 (15.2) | 132 | 0.008 | |
| Yes | 33 (18.3) | 27 (15.0) | 63 (35.0) | 57 (31.7) | 180 | |||
| Feeling lazy and unmotivated | No | 32 (29.1) | 23 (20.9) | 36 (32.7) | 19 (17.3) | 110 | 0.062 | |
| Yes | 39 (19.3) | 35 (17.3) | 70 (34.7) | 58 (28.7) | 202 | |||
| Do not want others to see me in workout clothes or exercising | No | 60 (22.1) | 49 (18.1) | 97 (35.8) | 65 (24.0) | 271 | 0.385 | |
| Yes | 11 (26.8) | 9 (22.0) | 9 (22.0) | 12 (29.3) | 41 | |||
| Information seeking skills | Lack of information related to classes, sports, locations, events etc. or do not know how to search for it | No | 38 (28.6) | 32 (24.1) | 41 (30.8) | 22 (16.5) | 133 | 0.003 |
| Yes | 33 (18.4) | 26 (14.5) | 65 (36.3) | 55 (30.7) | 179 | |||
| Not good at using a smartphone and miss calls or information | No | 39 (31.7) | 29 (23.6) | 32 (26.0) | 23 (18.7) | 123 | <0.001 | |
| Yes | 32 (16.9) | 29 (15.3) | 74 (39.2) | 54 (28.6) | 189 | |||
| Difficulty finding information due to poor eyesight | No | 40 (30.8) | 29 (22.3) | 37 (28.5) | 24 (18.5) | 130 | 0.004 | |
| Yes | 31 (17.0) | 29 (15.9) | 69 (37.9) | 53 (29.1) | 182 | |||
| Environment physical constraints | The place for exercising is far away or has inconvenient transportation | No | 54 (25.6) | 41 (19.4) | 64 (30.3) | 52 (24.6) | 211 | 0.165 |
| Yes | 17 (16.8) | 17 (16.8) | 42 (41.6) | 25 (24.8) | 101 | |||
| No facilities I can use near from my residence | No | 50 (23.5) | 43 (22.2) | 71 (33.3) | 49 (23.0) | 213 | 0.646 | |
| Yes | 21 (21.4) | 15 (15.3) | 35 (35.7) | 27 (27.6) | 98 | |||
| Poor facilities | No | 55 (23.7) | 44 (19.0) | 77 (33.2) | 56 (24.1) | 232 | 0.437 | |
| Yes | 12 (31.6) | 9 (23.7) | 8 (21.1) | 9 (23.7) | 38 | |||
| Lack of time | No | 44 (19.8) | 42 (18.9) | 74 (33.3) | 62 (27.9) | 222 | 0.096 | |
| Yes | 27 (30.0) | 16 (17.8) | 32 (35.6) | 15 (16.7) | 90 | |||
| A large number of participants and uncomfortable environment | No | 45 (24.5) | 40 (21.7) | 58 (31.5) | 41 (22.3) | 184 | 0.430 | |
| Yes | 10 (26.3) | 10 (26.3) | 14 (36.8) | 4 (10.5) | 38 | |||
| Difficulty in obtaining opportunities to register or apply | No | 34 (23.4) | 36 (24.8) | 41 (28.3) | 34 (23.4) | 145 | 0.076 | |
| Yes | 21 (32.3) | 11 (16.9) | 25 (38.5) | 8 (12.3) | 65 | |||
| A predominance of a specific sex or age group among people who exercise | No | 40 (24.8) | 36 (22.4) | 46 (28.6) | 39 (24.2) | 161 | 0.411 | |
| Yes | 14 (26.9) | 10 (19.2) | 20 (38.5) | 8 (15.4) | 52 | |||
| Program-related aspects or personal concerns | Lack of knowledge about exercise methods | No | 32 (35.2) | 21 (23.1) | 24 (26.4) | 14 (15.4) | 91 | <0.001 |
| Yes | 38 (17.3) | 37 (16.8) | 82 (37.3) | 63 (28.6) | 220 | |||
| Concern about pain or injury caused by exercising | No | 38 (39.6) | 20 (20.8) | 23 (24.0) | 15 (15.6) | 96 | <0.001 | |
| Yes | 33 (15.3) | 38 (17.6) | 83 (38.4) | 62 (28.7) | 216 | |||
| Fatigue or exhaustion | No | 32 (36.0) | 21 (23.6) | 23 (25.8) | 13 (14.6) | 89 | <0.001 | |
| Yes | 39 (17.5) | 37 (16.6) | 83 (37.2) | 64 (28.4) | 223 | |||
Regarding psychological or emotional constraints, “the absence of someone to exercise with” differed significantly across age groups (p = 0.008). Additionally, significant age-group differences were observed for all items related to information seeking skills, including “lack or information regarding exercise classes or programs” (p = 0.003), “difficulty using smartphones to obtain relevant information” (p < 0.001), and “challenges in seeking information due to poor eyesight” (p = 0.004).
A similar pattern was observed for items related to program-related or personal concerns. “Lack of knowledge about exercise methods,” “concerns about pain or injury,” and “fatigue or exhaustion as barriers to exercise participation” all showed significant age-group differences (all p < 0.001). In contrast, no significant age-group differences were found for economic constraints or environmental or physical constraints as exercise barriers. Collectively, these results suggest that certain barriers to exercise participation vary across age groups among older adults.
Table 2 summarizes the results of post-hoc analyses using adjusted residuals with Bonferroni correction, which revealed distinct age-group patterns in reported barriers to exercise. Participants aged 65-75 years were significantly underrepresented across several barrier categories, including “absence of someone to exercise with” (z = −2.2, p = 0.028), “lack of exercise-related information” (z = −2.1, p = 0.036), “difficulty using smartphones to obtain information” (z = −3.0, p = 0.003), “difficulty seeking information due to poor eyesight” (z = −3.4, p = 0.001), “lack of knowledge about exercise methods” (z = −4.7, p < 0.001), “concerns about pain or injury caused by exercise” (z = −3.5, p = 0.001), and “fatigue or exhaustion” (z = −2.2, p = 0.028).
Table 2.
Post-hoc comparison of age-group differences in reported exercise barriers using adjusted residuals
| Age category |
|||||
|---|---|---|---|---|---|
| 65–75 | 76–80 | 81–85 | 86+ | ||
| N (%) | N (%) | N (%) | N (%) | ||
| Reasons for lack of exercising | Adjusted z score (p) | Adjusted z score (p) | Adjusted z score (p) | Adjusted z score (p) | |
| Psychological or emotional constraints | Absence of someone to exercise with | -2.2 (0.028) | -1.9 (0.057) | 0.4 (0.689) | 3.3 (0.001) |
| Information seeking skills | Lack of information related to classes, sports, locations, events etc. or do not know how to search for it | -2.1 (0.036) | -2.1 (0.036) | 1 (0.317) | 2.9 (0.004) |
| Not good at using a smartphone and miss calls or information | -3 (0.003) | -1.8 (0.072) | 2.4 (0.016) | 2 (0.046) | |
| -2.9 (0.004) | -1.4 (0.162) | 1.7 (0.089) | 2.2 (0.028) | ||
| Difficulty finding information due to poor eyesight | -3.4 (0.001) | -1.3 (0.194) | 1.8 (0.072) | 2.4 (0.016) | |
| Program-related aspects or personal concerns | Lack of knowledge about exercise methods | -4.7 (0) | -0.7 (0.484) | 2.5 (0.012) | 2.5 (0.012) |
| Concern about pain or injury caused by exercising | -3.5 (0.001) | -1.4 (0.162) | 1.9 (0.057) | 2.6 (0.009) | |
| Fatigue or exhaustion | -2.2 (0.028) | -1.9 (0.057) | 0.4 (0.689) | 3.3 (0.001) | |
Participants aged 76-80 years showed no significant differences for most barrier items. In contrast, individuals aged 81-85 years were more likely to report “difficulty using smartphones to obtain information” (z = 2.4, p = 0.016) and “lack of knowledge about exercise methods” (z = 2.5, p = 0.012).
Participants aged ≥ 85 years were significantly overrepresented across multiple barrier categories, including “absence of someone to exercise with” (z = 3.3, p = 0.001), “lack of exercise-related information” (z = 2.9, p = 0.004), “difficulty using smartphones to obtain information” (z = 2.0, p = 0.046), “difficulty seeking information due to poor eyesight” (z = 2.4, p = 0.016), “lack of knowledge about exercise methods” (z = 2.5, p = 0.012), “concerns about pain or injury caused by exercise (z = 2.6, p = 0.009), and “fatigue or exhaustion” (z = 3.3, p = 0.001).
These findings indicate that barriers to exercise participation become more pronounced with advancing age, particularly among adults aged ≥ 85 years.
DISCUSSION
This study identified significant age-group differences in perceived barriers to exercise among older adults. Barriers related to psychosocial or emotional constraints, information seeking skills, and program-related aspects were more prevalent among individuals aged 81 years and older, particularly among those aged ≥ 86 years. These findings suggest that exercise barriers increase with advancing age, indicating that the oldest-old population may face greater psychological or emotional, informational, and program-related barriers in engaging in exercise.
These findings are generally consistent with those of previous studies reporting that barriers to physical activity tend to increase with advancing age [9,23]. However, the present study revealed a more complex and non-linear pattern. Specifically, exercise barriers did not increase consistently from the 65-75 years age group to the 76-80 years age group; however, these two groups were clearly distinguishable from the 81-85 and ≥ 86 years age groups, which reported exercise barriers more frequently.
The effect of age stratification was evident across all items with significant age-group differences (Table 1). Across all items related to information seeking skills and program-related aspects or personal concerns, individuals aged ≥ 81 years more frequently reported them as exercise barriers than did the respondents in the younger age groups (Table 2). The same pattern was observed for psychological or emotional constraints (Table 2). These findings suggest that barriers to exercise participation do not increase linearly with age but become more pronounced after 81 years. In particular, participants aged ≥ 85 years were significantly more likely to report exercise barriers than those aged 81-85 years.
Prevailing research has often attributed the non-participation of older adults in physical activity to depressive symptoms, aging-associated negative emotional states [24], or environmental constraints such as limited access to exercise facilities and unfavorable exercise conditions [25]. Our findings offer a different perspective, suggesting that the factors inhibiting exercise participation may be more closely related to the lack of relevant information and inability to search for and utilize such information, reflecting limited information literacy.
In recent years, interest in social media and digital platforms has increased among older adults in South Korea [26]. The use of these media extends beyond health information acquisition, as it enhances exercise motivation and actual engagement [27,28]. Furthermore, Korean older adults with high digital literacy exhibit better self-rated health and greater life satisfaction, whereas individuals with difficulties adapting to the digital environment show poorer self-rated health and lower life satisfaction [29].
However, in the present study, older age was associated with greater difficulty in navigating digital platforms and limited awareness of information-seeking strategies. Participants aged 65-75 years were significantly underrepresented in most barrier categories. In contrast, adults aged ≥ 85 years were overrepresented among those reporting difficulty using a smartphone as an exercise barrier. Consequently, older participants reported a lack of relevant information as a barrier to exercise. Similarly, participants’ concerns about pain, injury, fatigue, and exhaustion appeared to reflect insufficient access to information on exercise modalities tailored to the health status and functional capacity of older adults. Collectively, these findings suggest that improving digital access and information seeking skills may reduce the barriers to exercise participation for older adults. In addition, the findings underscore the need for simplified and age-friendly exercise information strategies, particularly for adults aged ≥ 81 years.
Significant age-group differences were observed in an item related to psychological or emotional constraints, “absence of someone to exercise with,” with a more pronounced negative impact on the exercise participation of adults aged ≥ 81 years compared with that of adults aged 65-80 years. This result is likely linked to broader social realities in later life, such as an increase in single-person households following spousal loss and the cumulative experience of losing friends or peers who previously served as exercise companions. From this perspective, older adults’ exercise participation should be understood not only as an individual behavior determined by physical capacity or motivation but also as a socially embedded activity sustained through everyday interpersonal relationships. The absence of emotional support, encouragement, or exercise companions substantially reduces the likelihood of physical activity among older adults [30,31].
In summary, information seeking skills and social support are key determinants of exercise participation. Particularly, the constriction of social networks exerts an increasingly important influence, as individuals move to the oldest-old age group. These findings highlight the need for age-specific interventions to promote exercise among older adults. Integrated approaches that enhance information competency and social support are particularly required for the oldest-old.
Several limitations of this study should be acknowledged. First, the relatively small sample necessitates caution in generalizing the findings. Second, some participants were recruited from welfare and senior centers, which may introduce selection bias, as these individuals may differ from the broader older adult population. Third, the study sample exhibited a substantial sex imbalance, with a markedly higher proportion of female participants than male participants (females = 83.12%, males = 16.88%). As attitudes toward and behaviors related to exercise may differ based on sex, such imbalance may have affected the observed patterns of barriers. Nonetheless, this study provides meaningful insights, given the limited amount of empirical evidence on exercise barriers across age strata among older adults. Accordingly, the present findings may serve as foundational evidence to inform the design of future large-scale or longitudinal studies.
In conclusion, this study demonstrates that the factors limiting exercise participation among older adults tend to vary based on age group. Information seeking skills, exercise program-related aspects, personal concerns, and psychosocial constraints were demonstrated as salient barriers among adults aged ≥ 81 years and particularly more frequently reported among those aged ≥ 85 years. These findings underscore the limitations of treating older adults as a homogeneous group and highlight the importance of age-sensitive, targeted strategies to effectively promote exercise in later life.
Footnotes
ACKNOWLEDGMENT
This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2024S1A5C3A02043877).
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