Barriers and enabling factors to participation of older adults in physical activity/exercise prior to surgery

Abstract

Background: In the UK, 170,000 adults undergo major non-cardiac surgery annually. Of these approximately 100,000 will develop post-operative complications contributing to approximately 25,000 post-operative deaths. A substantial proportion (80%, 20,000) of post-operative deaths occur within high-risk populations that include adults aged ≥ 65 years. Cardiorespiratory fitness impacts positively on post-surgical outcomes and ‘fitter’ adults have the fewest post-operative complications. However, a majority of older adults are inactive/unfit and report multiple barriers to engaging in physical activity/exercise. Methods: Five Theoretical Domain Framework-based focus group discussions were conducted with a purposive sample of 28 adults aged ≥ 65 years. The participants were enrolled in an RCT to assess the effect of two exercise interventions on cardiorespiratory fitness. Focus group discussions identified barriers and enabling factors to engagement in physical activity/exercise in the context of pre-surgery. Focus group discussions were audio recorded, transcribed verbatim and content analysed. Results: Barriers to physical activity/exercise in the pre-surgical period fell broadly into three theoretical domains: environmental context and resources; social influences; and emotion. Enabling factors into five theoretical domains: knowledge; beliefs about consequences; behavioural regulation; reinforcement and memory, attention and decision processes. A tailored approach to increasing physical activity/exercise, feedback and proximity of services were dominant themes identified across discussions. Discussion: Engaging older adults in physical activity/exercise prior to surgery necessitates a tailored multi-factorial approach that addresses knowledge, attitudes, social influence, self-regulatory capacity and incentivisation. Future research will develop co-designed intervention prototypes to assess usability and acceptability to older adults during the pre-surgical period.