Abstract
Objective
Maintaining life satisfaction may aid in multimorbidity resilience. As the prevalence of multimorbidity continues to rise in Canada, understanding modifiable factors that can influence life satisfaction among people with multimorbidity is warranted. This study aimed to examine the relationship between physical activity and life satisfaction among adults affected by multimorbidity.
Methods
Cross-sectional data from the 2015–2018 cycles of the Canadian Community Health Survey were used; 22,851 respondents with multimorbidity aged 20 years and older were included. Multiple linear regression models were used to investigate the relationship between physical activity (sedentary, somewhat active, moderately active, active) and life satisfaction for the whole population and for those having specific types of chronic conditions, controlling for self-perceived health status and sociodemographic factors.
Results
Respondents affected by multimorbidity who were somewhat active (β = 0.20, 95% CI: 0.08, 0.32), moderately active (β = 0.28, 95% CI: 0.13, 0.44), and active (β = 0.29, 95% CI: 0.17, 0.41) were more satisfied with life than respondents who had a sedentary lifestyle. The relationship between physical activity and life satisfaction was also found to be statistically significant in sub-populations of respondents affected by cancer, diabetes, chronic respiratory diseases, and mental health disorders but not cardiovascular diseases.
Conclusion
Physical activity may contribute to better life satisfaction among adults with multimorbidity. As multimorbidity increases in Canada, further investigation on the relationship between physical activity and life satisfaction is warranted to help improve interventions to cope with the effects of multimorbidity.
Keywords: Multimorbidity, Chronic disease, Life satisfaction, Physical activity, Canada
Résumé
Objectif
Le maintien de la satisfaction à l’égard de la vie peut aider la résistance à la multimorbidité. Alors que la prévalence de la multimorbidité continue de monter au Canada, il est justifié de comprendre les facteurs modifiables qui peuvent influencer la satisfaction à l’égard de la vie des personnes ayant une multimorbidité. Cette étude visait à examiner la relation entre l’activité physique et la satisfaction à l’égard de la vie chez les adultes ayant la multimorbidité.
Méthodes
Les informations transversales des cycles 2015-2018 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) ont été utilisées; 22 851 répondants multimorbides âgés de 20 ans et plus ont été inclus. Les modèles de régression linéaire multiple ont été utilisés pour examiner la relation entre le niveau d’activité physique (inactive, quelque peu actif, modérément actif, actif) et la satisfaction à l’égard de la vie pour l’entier de la population et pour ceux qui souffrent d’un type spécifique de maladies chroniques, contrôlant pour état de santé perçu et les facteurs sociodémographiques.
Résultats
Les répondants affectés par la multimorbidité qui étaient quelque peu actifs (β = 0,20, IC à 95% : 0,08 à 0,32), modérément actifs (β = 0,28, IC à 95% : 0,13 à 0,44), et actifs (β = 0,29, IC à 95% : 0,17 à 0,41) étaient plus satisfaits à l’égard de la vie que les répondants avec un mode de vie plus sédentaire. La relation entre l’activité physique et la satisfaction à l’égard de la vie est statistiquement significative dans les sous-populations des répondants affectées par le cancer, le diabète, les maladies respiratoires chroniques et les troubles de santé mentale, mais pas les maladies cardiovasculaires.
Conclusion
L’activité physique peut contribuer à une meilleure satisfaction à l’égard de la vie pour les adultes ayant une multimorbidité. À mesure que la multimorbidité augmente au Canada, une enquête plus approfondie sur la relation entre l’activité physique et la satisfaction à l’égard de la vie est justifiée pour aider à améliorer les interventions visant d’affronter les effets de la multimorbidité dans la population canadienne.
Mots-clés: Multimorbidité, maladies chroniques, satisfaction à l’égard de la vie, activité physique, Canada
Introduction
Multimorbidity, the co-occurrence of multiple chronic illnesses, is increasing within Canada, especially among older adults (Roberts et al., 2015). Based on the public health definition of multimorbidity, it is estimated that among Canadians 20 years and older, 8.9% are affected by at least two of the five major groups of chronic conditions (i.e., cancer, diabetes, cardiovascular diseases, chronic respiratory diseases, and mental health disorders) (Varin et al., 2019). These rates are expected to increase as a consequence of Canada’s aging population and a rise in prevalence of chronic conditions such as type 2 diabetes and hypertension (Feely et al., 2017). Multimorbidity has significant health, economic, social, and psychological impacts as people living with multiple chronic conditions face increased risks of disability, higher health care costs, greater feelings of social isolation, and lowered perceptions of well-being (Wister et al., 2016a).
Although multimorbidity has become a key public health issue, there exists a lack of a consensus on how this health condition is conceptualized, leading to variations in multimorbidity case definitions across studies. The most common method of defining multimorbidity is to determine the presence of two or more chronic conditions from a list of predefined illnesses. This is the approach we take in this study where we determine the presence of two or more conditions from the five major groups of chronic conditions set by the Public Health Agency of Canada’s (PHAC) Canadian Chronic Disease Indicators (CCDI) Steering Committee (Canadian Chronic Disease Indicators Steering Committee, 2017). Other approaches have considered the presence of two or more and also three or more conditions from a list of nine conditions (Roberts et al., 2015), while another has considered the presence of two or more and also three or more conditions from a list of seven conditions grouped into five categories (Feely et al., 2017). Such variations in multimorbidity case definitions can present challenges when attempting to compare these measures between studies. Flexibility in the case definition can be beneficial when data on specific chronic conditions may be limited.
Links between multimorbidity and life satisfaction have been identified in the literature, with lower levels of life satisfaction being observed among adults with multimorbidity (Wister et al., 2016a). Life satisfaction is both an aspect of quality of life, that includes physical, mental, and social well-being, as well as a component of psychological well-being (Rosella et al., 2019). A population-based cohort study using the 2003 to 2008 cycles of the Canadian Community Health Survey (CCHS) showed that among Canadian adults, a lower level of life satisfaction was a significant risk factor for chronic disease and death, independent of sociodemographic factors (Rosella et al., 2019). Studies suggest that those with lower levels of life satisfaction may engage more frequently in unhealthy behaviours which influence their risk of mortality (Rosella et al., 2019). Life satisfaction has also been implicated in multimorbidity resilience, which is a growing area of research aimed at identifying the ways in which individuals cope with multimorbidity and maintain their sense of well-being (Wister et al., 2016b). As there is a plethora of detrimental effects associated with multimorbidity, including sporadic feelings of pain, impairment in functioning, feelings of psychological distress, low self-esteem, and changes in social role, being able to achieve and maintain higher levels of life satisfaction is an important coping mechanism when faced with the negative consequences of multimorbidity (Wister et al., 2016b).
Although multimorbidity is associated with lower levels of life satisfaction, the literature suggests that physical activity may attenuate this relationship (Cimarras-Otal et al., 2014). The positive health benefits of physical activity are well known (Warburton & Bredin, 2017), with physical activity contributing to better quality of life by improving physical strength, cognitive performance, social interactions, and life expectancy (Cimarras-Otal et al., 2014). Among older adults with chronic diseases, higher levels of life satisfaction have been observed among those who were more physically active as opposed to those who were less physically active (Elavsky et al., 2005). Physical activity has also been shown to ameliorate feelings of stress, anxiety, and depression among people with chronic diseases (Hudon et al., 2008). Chiang et al. (2020), for instance, concluded that exercise improves health-related quality of life in patients with cardiometabolic multimorbidity. Similarly, Pedersen and Saltin (2015) examined the role of exercise as a potential treatment for 26 different chronic diseases and suggested that physical activity could enhance the quality of life among those living with chronic diseases. As summarized by Pedersen and Saltin (2015), many studies have shown the benefits of physical activity for individuals living with type 2 diabetes and those with chronic obstructive pulmonary disease, while physical activity in those with cardiovascular disease has demonstrated positive effects on function and mortality. Physical activity has been found to positively impact the physical well-being of individuals living with cancer, and modest results have been found for those living with mental illnesses (Pedersen & Saltin, 2015). Thus, physical activity could serve as a promising avenue to increase life satisfaction among people with multimorbidity.
At present, the relationship between physical activity and life satisfaction among people affected by multimorbidity has not yet been studied in Canada. As physical activity is a modifiable lifestyle factor, assessing the nature of this relationship can prove valuable for program and policy makers, as rates of multimorbidity continue to rise. Thus, the overall objective of this study was to assess the relationship between physical activity and life satisfaction among people with multimorbidity. An individual’s ability to engage in physical activity and their satisfaction with life may be impacted by their overall health status and may differ across chronic conditions (Elshahat et al., 2021; Glowacki et al., 2017; Matin et al., 2017; Megari, 2013; Nicholson et al., 2013; Pinto et al., 2016). For example, some people who have suffered from the effects of stroke lack the ability to drive, and as such are unable to access exercise facilities (Nicholson et al., 2013). Different types of cancer patients at varying treatment stages have also reported that treatment-related side effects (e.g., fatigue, gastrointestinal problems, joint pain) have deterred them from engaging in physical activity (Elshahat et al., 2021). Among people with depression, barriers to engaging in physical activity include lack of energy and feelings of tiredness (Glowacki et al., 2017). In addition, self-perceived health used as a global measure of health status and severity of chronic conditions has been shown to impact the relationship between physical activity and life satisfaction in other populations (Matin et al., 2017; Pinto et al., 2016). Marques et al. (2018) conducted a European cross-sectional study which found an interaction effect between multimorbidity and physical activity in terms of self-perceived health and life satisfaction. To account for the potential differences in ability to engage in physical activity across people affected by different chronic conditions, we assessed whether the relationship between physical activity and life satisfaction differs among individuals diagnosed with different chronic conditions while controlling for self-perceived health and sociodemographic factors as potential confounders of this relationship.
Methods
Data
This study used data from the 2015 to 2018 cycles of the CCHS. The CCHS collects health-related data including health status, health care utilization, and health determinants. The survey is used for regional, provincial, and national research as well as for surveillance programs. Completion of this survey is done on a voluntary basis and all constructs are assessed using self-reported measures. CCHS data are collected from individuals aged 12 years and older, excluding people living in institutions and on reserves, members of the military, and children aged 12 to 17 who are in foster care. In total, over 222,949 individuals responded to the 2015 to 2018 cycles of CCHS (Matin et al., 2017). This study used the public use microdata file (PUMF). Ethics approval was not required for this study.
Study population
For this study, we selected 23,169 respondents 20 years and older who have multimorbidity, using a public health definition of multimorbidity proposed by PHAC’s CCDI Steering Committee; that is, multimorbidity was defined as the co-occurrence of two or more of the five major categories of chronic diseases: cancer (ever had), cardiovascular disease (heart disease and/or stroke), chronic respiratory diseases (asthma and/or chronic obstructive pulmonary disease [COPD]), diabetes and mental illness (mood and/or anxiety disorders) (Canadian Chronic Disease Indicators Steering Committee, 2017). CCHS respondents were asked whether they were diagnosed with any of the aforementioned conditions that were expected to last or have lasted 6 months. For COPD, only respondents aged 35 years and older were asked about having this condition and younger respondents were assumed not to be affected by COPD. After removal of 1472 survey responses provided in proxy interviews, a final sample of 21,697 respondents was included in the analysis. Proxy responses were removed as certain questions that could be sensitive in nature were not asked during proxy interviews.
In total, 8.0% of respondents had at least one missing data point. We used the fully conditional method to impute missing data points for all variables in the statistical model. Specifically, we used the discriminant function for nominal categorical variables, logistic regression with cumulative logit for ordinal categorical variables, and predictive mean matching for our outcome variable. There were no differences in the statistical significance or size of parameter estimates between the results based on listwise deleted data and results based on 50 imputed data files.
Measurement instruments
The volume of weekly physical activity in CCHS was measured by calculating metabolic equivalents (METs) minutes per week (METs*mins/week) by intensity level, with three METs for moderate physical activity and six METs for vigorous activity. The derived Statistics Canada measure of physical activity used in our study was based on activity volume recommended by the World Health Organization and consisted of four profiles (i.e., sedentary [no physical activity in the last 7 days], somewhat active [volume less than the minimum recommendation for being physically active], moderately active [volume meets the minimum WHO recommendation for being physically active], active [volume equal to or greater than the WHO recommendation for health benefits]). Satisfaction with life, the outcome variable, was measured by the following question: “How do you feel about your life as a whole right now?” We assumed that this subjective assessment of global well-being, measured on an 11-point scale ranging from 0 “very dissatisfied” and 10 “very satisfied,” is a continuous variable. Self-perceived health was measured using responses to the question: “In general would you say your health is...?”; responses to this question were dichotomized into “good” (“excellent,” “very good,” “good”) or “fair/poor” (“fair,” “poor”). Finally, age (20–44, 45–64, 65–84, and 85 and over), sex (male, female), ethno-cultural background (Caucasian, non-Caucasian), immigration status (born in Canada, immigrant), marital status (single, married/living common-law, separated/divorced/widowed), and household income (total income before taxes and deductions received by all household members, from all sources; missing values for this variable were imputed by Statistics Canada) were included as control variables.
Statistical analysis
The linear regression analysis was used to assess the relationship between physical activity and life satisfaction. First, in model 1, we estimated the relationship between physical activity and life satisfaction, controlling for the effects of self-perceived health, and sociodemographic factors (i.e., age, sex, ethno-cultural background, immigration status, household income, marital status). Additionally, in model 2, we assessed the nature of this relationship for respondents affected by different types of chronic conditions (i.e., cancer, diabetes, cardiovascular diseases, chronic respiratory diseases, mental health disorders). The F-test was used to assess differences in the level of life satisfaction across categories of physical activity. Rescaled sampling weights with an average of 1 and bootstrap weights provided by Statistics Canada were used to extrapolate the results to the population of residents of Canada affected by multimorbidity and to account for the CCHS sampling design. All statistical analyses were performed in SAS version 9.4 using MI/MIANALYZE and SURVEYREG procedures (SAS Institute Inc., 2013).
Results
The characteristics of the study sample are presented in Table 1. The most prevalent groups of chronic conditions were mental health disorders (54.1%), respiratory disorders (52.7%), and diabetes (42.1%). Across the sample, 31.6% of the respondents indicated that they had a sedentary lifestyle, while 29.2% were active, 14.0% were moderately active, and 21.4% were somewhat active. Finally, 41.5% of respondents reported their health was either fair or poor.
Table 1.
Characteristics of CCHS participants with multimorbidity
| Frequency (N)* | Percent (%)** | |
|---|---|---|
| Age (years) | ||
| 20–44 | 2868 | 18.7 |
| 45–64 | 7530 | 39.1 |
| 65–84 | 8486 | 32.6 |
| 85 and over | 2813 | 9.6 |
| Sex | ||
| Female | 12,834 | 57.5 |
| Male | 8863 | 42.5 |
| Marital status | ||
| Single | 3816 | 18.3 |
| Married/living common-law | 9876 | 56.3 |
| Separated/divorced/widowed | 7949 | 25.2 |
| Non-response | 56 | 0.2 |
| Household income*** | ||
| Less than $20,000 | 4128 | 14.3 |
| $20,000–$39,999 | 6001 | 23.3 |
| $40,000–$59,999 | 3841 | 17.5 |
| $60,000–$79,999 | 2517 | 13.2 |
| $80,000 or more | 5191 | 31.7 |
| Non-response | 19 | 0.1 |
| Education | ||
| Less than secondary school graduation | 5653 | 21.6 |
| Secondary school graduation | 5020 | 24.7 |
| Post-secondary | 10,663 | 51.6 |
| Non-response | 361 | 2.2 |
| Ethno-cultural background | ||
| Caucasian | 18,699 | 81.2 |
| Non-Caucasian | 2545 | 15.9 |
| Non-response | 453 | 2.9 |
| Immigration status | ||
| Born in Canada | 18,838 | 80.1 |
| Immigrant | 2438 | 17.4 |
| Non-response | 421 | 2.5 |
| Physical activity | ||
| Sedentary | 7449 | 31.6 |
| Somewhat active | 4618 | 21.4 |
| Moderately active | 2855 | 14.0 |
| Active | 5910 | 29.2 |
| Non-response | 865 | 3.9 |
| Perceived health | ||
| Good | 12,047 | 58.0 |
| Fair/poor | 9585 | 41.5 |
| Non-response | 65 | 0.4 |
| Chronic conditions | ||
| Diabetes | 9389 | 42.1 |
| Respiratory | 11,046 | 52.7 |
| Cardiovascular disease | 8748 | 36.8 |
| Cancer | 9064 | 38.2 |
| Mental health | 10,879 | 54.1 |
| Survey year | ||
| 2015–2016 | 10,400 | 47.9 |
| 2017–2018 | 11,297 | 52.1 |
Source: 2015–2018 Canadian Community Health Survey
Total unweighted sample = 21,697
Total weighted sample = 21,697
* Unweighted frequencies (they represent distribution of respondents in the sample and should not be considered representative of the study target population)
** Weighted percentages (they represent the study target population)
*** Missing values for this variable were imputed by Statistics Canada, except for 19 respondents
As indicated in Table 2, on a scale from 0 (very dissatisfied) to 10 (very satisfied), the average level of satisfaction with life was 7.03 (95% CI: 6.99–7.08) and there was no statistically significant difference in the level of satisfaction between males (7.05; 95% CI: 6.99–7.12) and females (7.02; 95% CI: 6.96–7.08). However, there were some significant differences in the outcome variable across respondents with different profiles of physical activity. Specifically, those in the sedentary group (6.74; 95% CI: 6.66–6.83) were significantly less satisfied with life than respondents who reported to be somewhat active (7.07; 95% CI: 6.98–7.16), moderately active (7.26; 95% CI: 7.14–7.37), or active (7.21; 95% CI: 7.14–7.29); there were no statistically significant differences between the three latter groups.
Table 2.
Level of satisfaction among subgroups of CCHS participants with multimorbidity
| Subgroup | Mean (CI) | Median (IQR) |
|---|---|---|
| All respondents | 7.03 (6.99 – 7.08) | 6.97 (5.15 – 7.95) |
| Sedentary | 6.74 (6.66 – 6.83) | 6.77 (4.89 – 7.87) |
| Somewhat active | 7.07 (6.98 – 7.16) | 6.95 (5.28 – 7.94) |
| Moderately active | 7.26 (7.14 – 7.37) | 7.09 (5.54 – 8.06) |
| Active | 7.21 (7.14 – 7.29) | 7.05 (5.58 – 8.03) |
| Male | 7.05 (6.99 – 7.12) | 7.01 (5.20 – 7.97) |
| Female | 7.02 (6.96 – 7.08) | 6.94 (5.11 – 7.94) |
Note: Estimates provided are from the weighted sample
CI confidence interval, IQR interquartile range
The results from model 1 indicate that, after controlling for the self-perceived health and sociodemographic characteristics, there were statistically significant differences in the level of satisfaction with life across individuals with different profiles of physical activity (F-test=7.38; p<0.001). Specifically, those in the somewhat active, moderately active, and active groups had 0.20 (95% CI: 0.08–0.32), 0.22 (95% CI: 0.13–0.44), and 0.29 (95% CI: 0.17–0.41), respectively, higher levels of satisfaction than those in the sedentary group (see Table 3). There were, however, no statistically significant differences across respondents with the three physically active profiles. Additionally, as expected, respondents with poorer self-perceived health had lower levels of satisfaction (−1.78; 95% CI: −1.87 to −1.68).
Table 3.
Adjusted estimates of the relationship between the level of physical activity and the level of life satisfaction of CCHS participants with multimorbidity
| Model 1 | ß | 95% CI | F-Test |
|---|---|---|---|
| Intercept | 7.28* | 7.05, 7.51 | 21,328.10*** |
| Physical activity | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.20* | 0.08, 0.32 | 7.38*** |
| Moderately active | 0.28* | 0.13, 0.43 | |
| Active | 0.29* | 0.16, 0.41 | |
| Self-perceived health | |||
| Good (R) | - | 1304.77*** | |
| Fair/poor | −1.77* | −1.87, −1.68 | |
| Age (years) | |||
| 20–44 (R) | - | 55.25*** | |
| 45–64 | −0.06 | −0.20, 0.08 | |
| 65–84 | 0.53* | 0.39, 0.67 | |
| 85 and over | 0.69* | 0.50, 0.88 | |
| Sex | |||
| Female (R) | - | 2.17 | |
| Male | −0.07 | −0.17, 0.02 | |
| Ethno-cultural background | |||
| White (R) | - | 2.59 | |
| Non-white | −0.10 | −0.24, 0.05 | |
| Immigration status | |||
| Born in Canada (R) | - | 11.76*** | |
| Immigrants | −0.22* | −0.36, −0.09 | |
| Marital status | |||
| Married/living common-law (R) | - | 44.53*** | |
| Single | −0.53* | −0.68, −0.39 | |
| Separated/divorced/widowed | −0.44* | −0.55, −0.32 | |
| Household income | |||
| Less than $20,000 (R) | - | 18.78*** | |
| $20,000–$39,999 | 0.28* | 0.12, 0.44 | |
| $40,000–$59,999 | 0.37* | 0.18, 0.55 | |
| $60,000–$79,999 | 0.50* | 0.31, 0.68 | |
| $80,000 or more | 0.64* | 0.46, 0.81 | |
| Survey year | |||
| 2015–2016 (R) | - | 0.29 | |
| 2017–2018 | 0.00 | −0.09, 0.08 | |
Note: Values shown are based on imputed data, with sampling and bootstrap weights applied. Results are significant when the 95% confidence interval excludes the null value of 0 (*), otherwise results are significant when p < 0.05 (**) or p < 0.001 (***)
CI confidence interval, R reference category, SE standard error
In models 2A–2E, we assessed the relationship between physical activity and the level of life satisfaction for respondents having a specific type of chronic condition, controlling for the self-perceived health and sociodemographic characteristics. Overall, differences in the level of satisfaction among respondents with different physical activity profiles were statistically significant across respondents with diabetes (F-test = 6.25; p<0.001), chronic respiratory disease (F-test = 2.95; p = 0.03), cancer (F-test = 6.35; p<0.001), and mental health disorders (F-test = 6.590; p<0.001). No statistically significant differences were found among respondents with cardiovascular disease (F-test = 2.68; p = 0.05). Specifically, those who were active had statistically higher levels of satisfaction than their sedentary counterparts (diabetes: ß= 0.32, 95% CI: 0.13–0.52; respiratory: ß= 0.23, 95% CI: 0.06–0.39; cancer: ß= 0.31, 95% CI: 0.12–0.50; mental health: ß= 0.39, 95% CI: 0.21–0.56). Higher levels of life satisfaction among those who were somewhat active and moderately active, comparing to those who were sedentary, were statistically significant only for respondents who had diabetes, cancer, and mental health disorders (see Table 4).
Table 4.
Adjusted estimates of the relationship between physical activity and the level of satisfaction with life for respondents with specific chronic conditions
| ß | 95% CI | F-Test | |
|---|---|---|---|
| Model 2A - Diabetes | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.36* | 0.17, 0.54 | 6.25*** |
| Moderately active | 0.47* | 0.21, 0.73 | |
| Active | 0.32* | 0.13, 0.52 | |
| Model 2B - Respiratory | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.04 | -0.13, 0.20 | 2.95** |
| Moderately active | 0.17 | -0.04, 0.38 | |
| Active | 0.23* | 0.06, 0.39 | |
| Model 2C - Cardiovascular | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.29* | 0.09, 0.48 | 2.68 |
| Moderately active | 0.18 | -0.08, 0.43 | |
| Active | 0.26* | 0.05, 0.47 | |
| Model 2D - Cancer | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.30* | 0.13, 0.46 | 6.35*** |
| Moderately active | 0.36* | 0.18, 0.55 | |
| Active | 0.31* | 0.12, 0.50 | |
| Model 2E - Mental Health | |||
| Sedentary (R) | - | ||
| Somewhat active | 0.25* | 0.07, 0.43 | 6.59*** |
| Moderately active | 0.37* | 0.18, 0.57 | |
| Active | 0.39* | 0.21, 0.56 | |
Note: All models were adjusted for the same covariates as Model 1. Values shown are based on imputed data, with sampling and bootstrap weights applied. Results are significant when the 95% confidence interval excludes the null value of 0 (*), otherwise results are significant when p < 0.05 (**) or p < 0.001 (***).
CI confidence interval, R reference category, SE standard error
Discussion
The present study examined the relationship between physical activity and life satisfaction among adults who have multimorbidity. Overall, respondents who were sedentary had significantly lower levels of life satisfaction than those who were physically active, adjusting for sociodemographic characteristics and self-perceived health. With the exception of respondents affected by cardiovascular disease, the relationship between physical activity and life satisfaction was found to be statistically significant among those affected by cancer, diabetes, chronic respiratory diseases, and mental health disorders.
Life satisfaction is an important health outcome in population health studies (Nes et al., 2013), and it has been shown that chronic disease and multimorbidity are associated with lower levels of satisfaction (Wister et al., 2016a). Studies assessing adults with chronic diseases have reported positive relationships between physical activity and overall well-being (Chiang et al., 2020; Elavsky et al., 2005). Our findings support this position and suggest that even among people with multimorbidity, engaging in any physical activity (or not having a sedentary lifestyle) is linked with higher levels of life satisfaction. Partaking in physical activity may aid in alleviating pain and discomfort related to multiple chronic diseases, in conjunction with healthy nutrition and stress-relief strategies (Wister et al., 2016b). Furthermore, engaging in physical activity may lead to increases in self-efficacy and self-esteem, resulting in greater feelings of life satisfaction (Katula & McAuley, 2001; Tasiemski et al., 2005; Valliant et al., 1985).
Respondents with cancer, diabetes, chronic respiratory diseases, and mental health disorders who engaged in any physical activity were also found to have higher levels of life satisfaction. Our results are aligned with the literature which suggests that the positive effects of physical activity include increased survival and alleviation of fatigue among cancer patients (Pedersen & Saltin, 2015). Participating in physical activity can also enhance health-related quality of life and decrease the risk of mortality for people with chronic obstructive pulmonary disease and type 2 diabetes, respectively (Pedersen & Saltin, 2015). Furthermore, physical activity may benefit those with mental disorders by serving as a distraction (Pedersen & Saltin, 2015).
What this study adds
In the past, physical activity was shown to have a positive effect on life satisfaction in the general population (Elavsky et al., 2005; Hudon et al., 2008). It has also been suggested that maintaining one’s life satisfaction may be a useful strategy in coping with the negative effects of multimorbidity (Wister et al., 2016b). The current study focused on exploring the relationship between physical activity and satisfaction with life among people with multimorbidity. As physical activity was found to be associated with the level of life satisfaction, the findings of this study can inform future research on the positive role of physical activity in this population. Overall, the results provide important implications for Canada’s aging population with the increasing prevalence in multimorbidity, such as providing further evidence for promoting physical activity. Our results also showed that life satisfaction was lower among those with poorer self-perceived health. Given the inverse association between self-perceived health and multimorbidity (Marques et al., 2018), self-perceived health should be accounted for in studies assessing physical activity and life satisfaction among people with multimorbidity.
Strengths and limitations
A number of strengths and limitations should be acknowledged when interpreting the results of this study. The generalizability of the results is a strength of our study as the CCHS provided a large representative sample of the Canadian population affected by multimorbidity (Statistics Canada, 2020). Some limitations to consider include the cross-sectional design of the CCHS which implies that causal inferences cannot be made and that the directionality of the relationship between satisfaction with life and physical activity cannot be determined based on the results of this study as adults who are more satisfied with life may engage in healthier lifestyle habits such as increased physical activity (Rosella et al., 2019). All variables in the analyses were based on self-report and could be prone to bias. In particular, the actual level of physical activity could be under- or over-reported (Prince et al., 2008). Objective measures of physical activity, such as the use of accelerometers, could provide more reliable and accurate measures; however, they are rarely used in large observational studies (Steeves et al., 2019). Studies also suggest that self-reported measures of life satisfaction are reliable indicators and remain stable over time (Howell et al., 2007; Rosella et al., 2019). The selection of the sample of respondents affected by multimorbidity was based on the CCDI’s definition of multimorbidity (Canadian Chronic Disease Indicators Steering Committee, 2017). However, the overall prevalence of multimorbidity in our study could have been increased had more chronic conditions, such as obesity and hypertension, been included in our definition (Fortin et al., 2012). In addition, many chronic conditions such as different types of cancer or mental health disorders were grouped as broad categories of conditions, resulting in the inability to account for multiple conditions within the same group. As the severity of the chronic conditions was not considered directly, limitations associated with these conditions, such as mobility reductions, were not adjusted for in the analysis. There can also be some disadvantages in including comorbidities such as anxiety or depression in the definition of multimorbidity, which could have their unique associations with life satisfaction. However, this study did not explore individual chronic conditions so we can only draw conclusions about multimorbidity as an ensemble. Finally, a measure for gender identity was not available in the CCHS. Instead, sex at birth was used in this study, which may affect the interpretation of the findings, as some individuals may identify differently from their sex at birth.
Conclusion
The prevalence of multimorbidity is expected to rise with the aging of the Canadian population (Feely et al., 2017). Satisfaction with life may help mitigate the negative effects associated with multimorbidity (Wister et al., 2016b). Our study found that being physically active increased the level of life satisfaction among Canadian adults with multimorbidity. These findings suggest that physical activity could be beneficial in maintaining life satisfaction among people with multimorbidity. Studies with a longitudinal design may help determine the directionality of the relationship between physical activity and life satisfaction and corroborate our findings. Furthermore, future research examining this relationship should assess the role of domain-specific physical activity and account for the effects of self-perceived health.
Contributions to knowledge
What does this study add to existing knowledge?
Among adults with multimorbidity, those who engaged in physical activity had higher levels of life satisfaction than those with a sedentary lifestyle.
The relationship between physical activity and life satisfaction was also found to be statistically significant in sub-populations of multimorbid respondents affected by cancer, diabetes, chronic respiratory diseases, and mental health disorders but not cardiovascular diseases.
What are the key implications for public health interventions, practice, or policy?
Given the aging Canadian population and the increasing prevalence of multimorbidity, our findings provide further evidence for the importance of promotion of physical activity among individuals affected by multimorbidity.
Author contributions
RA, TL, GC, and PW conceptualized the study. PW analyzed and interpreted the data. All four authors drafted the paper and provided comments to revise the paper.
Data availability
Data were provided by Statistics Canada through the Research Data Centres program and accessed under the Statistics Act of Canada. The analyses and the interpretation are the authors’ alone.
Declarations
Ethics approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Conflict of interest
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
Data were provided by Statistics Canada through the Research Data Centres program and accessed under the Statistics Act of Canada. The analyses and the interpretation are the authors’ alone.