Lifestyle physical activity in hypertensive rural elders: Association with self-efficacy related constructs

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Hypertension is often amenable to secondary prevention through health behaviors such as regular exercise or increased levels of lifestyle physical activity (LPA), yet many hypertensives, especially elders, continue sedentary lifestyles. Self-efficacy (SE) is a salient cognitive factor in health behavior change & maintenance, however, most research is limited to the effects on exercise & not LPA behaviors. This study examined relationships among LPA, SE, outcome expectations (OE), physical health (PH), mental health (MH), & social support (SS) in a sample of rural, hypertensive elders.

Methods: A correlational design was used. Subjects were rural dwelling hypertensive elders (n=99), 83.8% female, 94.9% Caucasian, 57% married, 66.7%retired with mean age 70.19±6.95 years. Variables & measures were LPA (Physical Activity Scale for the Elderly; PASE), SE (SE for LPA scale), OE (OE for LPA scale), SS (Family & Friend SS for LPA scales), PH & MH (SF-36v2), Body Mass Index (BMI), perceived exertion (RPE), &Work/Volunteer time commitments. Multiple linear regression was used to determine the multivariate relationships of the variables with LPA & evaluate relationships with SE for LPA. Logistic regression was used to evaluate relationships with OE for LPA.

Results: PASE scores suggested the sample was sedentary. In univariate analysis, LPA scores were higher in participants with a lower BMI (r=-.27,p=.007) & lower RPE (r=-.35,p=.001). The proposed model predicted a small portion of variance (17%) in LPA. Perceived PH (p=.000) was the only independent predictor of LPA in the multivariate model. Greater perceived PH (p=.001) & MH(p=.012) were significantly associated with increased SE for LPA. Greater perceived PH (6%)& MH (8%) were significantly associated with increased odds of having high OE for LPA. Elders with full- or part-time work/volunteer commitments were significantly more active than those who were retired. DISCUSSION: SE was not as important an influence on LPA as perceived PH in this rural sample of elderly hypertensives. To improve LPA in older adults, clinicians should focus on developing interventions for those with lower PH & MH, increased BMI & increased RPE. Further research is required to understand the complex behavior of LPA in rural elders.