Enhancing engagement and motivation

Physical activity is essential for maintaining physical and mental health, preserving thus, functional capacity in older adults. Despite these benefits, physical activity levels tend to decline with age and many older people are considered sedentary or physically inactive. There are several guidelines and recommendations for physical activity in older adults, such as 150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate to vigorous-intensity physical activity per week, but the majority of older adults usually fail to meet the above recommendations (Bauman et al., 2016).

Physical activity levels in older adults influenced by a range of psycho-social factors that affect engagement and motivation. Understanding these factors is crucial for designing effective interventions to promote physical activity among older adults. Older people often have high dropout and non-adherence rates to different exercise programs due to lower self-efficacy in overcoming barriers to maintaining a physically active lifestyle (Mullen et al., 2013). Several socio-cognitive theories explain positive or negative changes in the behaviour of physical activity, taking into account environmental or personal variables in different populations. It seems however, that another important psychosocial factor that may affect physical activity in older adults is stereotypes.

Psychological Theories in Promoting Physical Activity

Table 1 summarizes the psychological theories mentioned above and their application to promoting physical activity in older adults. Socio-cognitive theories provide valuable insights into how motivation and behavioral change can be promoted in older adults. Two widely used frameworks in understanding health behavior change are the Theory of Planned Behavior and the Transtheoretical Model.

The Theory of Planned Behavior posits that intention is the primary predictor of behavior, influenced by three factors: a) attitudes toward the behavior, b) subjective norms, and c) perceived behavioral control. For older adults, perceived behavioral control is often a significant factor due to physical limitations or chronic conditions. However, enhancing perceptions of control, such as by emphasizing activities that accommodate various levels of ability, can improve engagement. For instance, a study by Conn et al. (2003) found that perceived behavioral control, along with behavioral beliefs, plays a significant role in predicting physical activity behavior. The findings suggest strategies to enhance perceived control can effectively promote exercise among older adults.

The Transtheoretical Model conceptualizes behavior change as a process through stages: 1) pre-contemplation, 2) contemplation, 3) preparation, 4) action, and 5) maintenance. People that don’t even think to change their behaviour are in the pre-contemplation stage. People that have been successfully through all the stages have changed their behaviour and are in the maintenance stage. Older adults may move more slowly through these stages due to accumulated health concerns or lower confidence in physical capabilities. Tailored interventions that recognize their current stage of readiness, and gradually build up motivation through small, achievable goals, have shown effectiveness. For example, research by Ratz et al. (2020) demonstrated that web-based intervention effects on physical activity stage, partly mediated by changes in task self-efficacy, intention, and action planning.

According to Self-Determination Theory, three basic psychological needs drive motivation: autonomy, competence, and relatedness. In the context of physical activity, promoting autonomy through choice, fostering competence by matching activities to skill levels, and enhancing relatedness through group exercises can significantly increase engagement. Older adults often prefer activities where they feel a sense of mastery, and enjoy activities that allow for social interaction. Therefore, programs should aim to meet these needs by offering a range of options and opportunities for skill development.

The Socioemotional Selectivity Theory underpins the differences in motivation for physical activity between younger and older adults. It suggests that as people age, their motivational focus shifts from acquiring knowledge and future-oriented goals to seeking emotional satisfaction and present-oriented goals. This theory has important implications for promoting physical activity in older adults. While younger adults may engage in exercise for long-term health benefits, older adults are more likely to be motivated by activities that provide immediate pleasure, social connections, or stress relief. Programs that emphasize the enjoyment of physical activity, such as group exercises with a social component or activities conducted in a scenic outdoor setting, are likely to be more appealing. In a study by Zimmer et al. (2023), older adults who participated in group-based activities reported higher levels of motivation and greater adherence compared to those who exercised alone, supporting the idea that social interactions play a critical role in sustaining physical activity.

Group activities may also enhance social support, which is a significant factor influencing physical activity in older adults. It can come from family, friends, or organized groups, providing encouragement, accountability, and companionship. Research shows that older adults who perceive higher levels of social support are more likely to participate in physical activity (Zimmer et al., 2023). Social support can also mitigate barriers, such as fear of injury, by fostering a sense of safety in numbers.

Stereotypes and Their Impact on Physical Activity in Older Adults

The limitations of functionality constitute an obstacle to the independent living of elderly individuals who are unable to meet the demands of daily life due to physical or cognitive restrictions and disability. The lifestyle of an elderly person is also shaped by the perceptions and stereotypes about aging that may prevail in the society in which they live. The age of over 65 is a period of life with much more free time, as it marks the phase of retirement and the gradual transition to a life with far fewer obligations. An elderly person could use this free time for physical activities they enjoy or to adopt new social roles. However, negative social stereotypes about aging may lead in the opposite direction, causing the elderly individual to limit both their social and physical activity, and instead of adopting new roles, they may end up withdrawing from social roles altogether. Table 2 summarizes common stereotypes and typical strategies to counter them.

A common stereotype is that older adults are "frail" or "physically weak." Such beliefs can foster a "culture of sedentary behavior," where older individuals avoid physical activity due to fear of injury or a perception that exercise is "not suitable" for their age. This can lead to a cycle of inactivity, where the lack of physical activity results in diminished physical fitness, further reinforcing the stereotype and increasing the fear of injury.

Research indicates that older adults often internalize these stereotypes, which can lead to "self-fulfilling prophecies." For example, Levy et al. (2002) found that older adults who held negative beliefs about aging were more likely to experience functional decline over time. Addressing these stereotypes is essential for encouraging older adults to remain active and challenge preconceived notions about their abilities.

Another prevalent stereotype is the notion that certain types of physical activity are not suitable for older adults, who should instead focus on "gentle" or "restorative" activities. While low-impact exercises like walking, stretching, and yoga can be beneficial, this mindset can discourage older adults from participating in more vigorous or varied forms of exercise, such as strength training or aerobic activities. However, studies have shown that older adults can safely and effectively engage in higher-intensity activities when these are appropriately adapted. For instance, resistance training has been shown to improve muscle mass and functional capacity even in adults over 70 years old (Fiatarone et al., 1990).

Gender-related stereotypes also influence physical activity behaviors in older adults. Older women may face social expectations that steer them away from certain activities, like weightlifting, that are perceived as "masculine." Similarly, older men may feel less inclined to participate in activities like yoga or dance, which are often stereotyped as "feminine." Such beliefs can limit the range of activities that older adults feel comfortable engaging in. Addressing gender stereotypes requires promoting inclusivity in all forms of physical activity and emphasizing that exercise can be tailored to meet individual needs, regardless of gender. Community programs that highlight the diverse benefits of various activities for both men and women can help break down these barriers.

Stereotypes about aging and physical activity can have a profound impact on the behavior and health of older adults. By addressing these stereotypes and creating supportive environments that promote diverse forms of physical activity, practitioners can help older adults overcome barriers and lead more active, fulfilling lives. Below are typical strategies that could challenge the ageism stereotypes, while Table 3 includes physical activity interventions that should not only motivate older adults to engage in physical activity, but also address the above stereotypes.

Strategies for Addressing Stereotypes

• Education and Awareness: Education programs that emphasize the benefits of physical activity for older adults of all ages and abilities can help reduce the impact of stereotypes. Public health campaigns showcasing older adults who engage in diverse forms of exercise can challenge myths about age-related limitations.
• Adapting Activities to Be Inclusive: Programs should be designed to cater to different fitness levels and offer modifications to make activities accessible to everyone. This approach allows individuals to experience success at their own pace, which can help to dispel negative stereotypes about their capabilities.
• Social Support and Community Engagement: Social environments can influence physical activity participation. Older adults are more likely to engage in exercise if they feel supported by peers and instructors. Group activities that combine social interaction with physical exercise can create a welcoming atmosphere that encourages older adults to challenge stereotypes and explore new forms of movement.

Smart wearables, such as fitness trackers and smartwatches, offer promising tools to engage older adults in regular physical activity. As described in chapter 2, these devices provide real-time feedback, health monitoring, and personalized insights that can promote motivation and support behavior change. In a recent meta-analysis, Liu at al. (2020) reviewed randomized controlled trials published between 2008 and 2018 to assess the impact of wearable activity trackers (WATs), such as Fitbit and other wearable devices, on physical activity, measured primarily through daily step counts and time spent on moderate-to-vigorous physical activity. They concluded that WAT-based interventions can effectively enhance PA among sedentary older adults over the short term, particularly when coupled with behavior change strategies. However, results are mixed when comparing WATs to traditional methods or involving very old participants, indicating a need for further research into long-term adherence and optimization of interventions for different age groups.

In order to understand how wearables may enhance engagement in physical activity interventions we should first understand the motives and the barriers of older adults to engage in physical activity and then see how wearables may be helpful in raising most of the barriers or enhance the facilitators. Table 4 presents a list of barriers and facilitators to physical activity for older adults.

Fear of Injury refers to the concerns of many older adults about falls or other injuries during exercise. It can be faced with access to safe, age-friendly environments, ensuring the availability of facilities that cater specifically to older adults.

Chronic Health Conditions, such as arthritis, heart disease, or mobility limitations may reduce confidence in participating in physical activities. Physicians and health practitioners can motivate older adults by emphasizing the health benefits of physical activity.

Environmental Factors, concern mainly lack of access to safe, age-appropriate facilities or parks that can discourage participation. Activities that incorporate social elements or are conducted in groups can provide a motivational boost.

There are also some factors that the fitness professional should consider. Older adults have diverse backgrounds and capabilities, so physical activity programs should be customized. Programs that offer a variety of activities (e.g., yoga, swimming, dancing) can appeal to different preferences and functional abilities. The immediate benefits of exercise should be spotted as soon as possible. Highlighting the immediate benefits of physical activity, such as improved mood, stress reduction, and social engagement, can be more effective than focusing solely on long-term health benefits. Incorporating social components into physical activity programs, such as exercise classes with a social hour afterward, can help older adults see physical activity as a social experience rather than a chore.

The Role of Smart Wearables in Promoting Physical Activity

Smart wearables can help older adults maintain health and manage chronic conditions by tracking vital signs and providing activity reminders. Features such as step counting, heart rate monitoring, sleep tracking, and fall detection make wearables particularly useful for this demographic. Moreover, these devices foster self-monitoring, enabling users to set personalized goals and receive real-time feedback. While younger populations may find the default settings of wearables suitable, older adults often require adaptations in usability features. Ensuring the devices accommodate physical limitations, such as reduced vision or manual dexterity, is key to increasing engagement. Table 5 presents the main strategies that could be used in order to enhance physical activity engagement through smart wearable features, along with some examples.

Personalization and adaptive feedback have been shown to enhance user engagement by tailoring experiences to individual needs. Wearables can adjust goals and notifications based on the user’s performance and preferences. The study by Peng et al. (2021) highlighted that tailored activity goals, personalized health recommendations, and adaptive feedback significantly improved adherence to physical activity regimens in older adults.

Gamifying physical activity can motivate older adults by introducing elements of fun and competition. Social features like sharing achievements and participating in challenges foster a sense of community. Jang et al. (2018) found that older adults were more likely to increase their activity levels when gamified elements such as badges and leaderboards were incorporated into wearable technology.

Table 6 summarizes key motivational features for wearables. Gamification strategies, such as earning badges or competing with friends, have shown potential in increasing engagement with fitness activities. Nurmi et al. (2020) developed a system integrating gamification with wearable devices to motivate users to increase their step counts. They found that combining goal-setting with digitalized motivational interviewing and small challenges can significantly boost activity levels in individuals aged 55 and older. Moreover, Vargemidis et al. (2020) emphasized that wearables with social sharing features—such as sharing progress with friends or joining activity challenges—can enhance motivation by fostering a sense of community. Older adults who are part of social groups tend to engage more actively, finding external accountability helpful in sustaining their fitness routines.

To ensure wearables are user-friendly for older adults, devices should feature simplified interfaces, larger fonts, and voice commands. Providing training or user manuals can also help. The review by Moore et al. (2021) showed that interventions improving device accessibility, such as larger text or easier navigation, were linked to higher engagement and lower dropout rates among older users.

Leveraging technology can enhance motivation, improve adherence to exercise programs, and support long-term engagement in healthy behaviors. Technology has the potential to address common barriers to physical activity in older adults, such as lack of motivation, safety concerns, and difficulty accessing fitness resources. By providing personalized feedback, monitoring progress, and offering reminders, technology-based interventions can help older adults stay committed to exercise programs.

Personalized feedback based on real-time data can help older adults understand their progress and set realistic goals. Tailoring feedback to individual health conditions or fitness levels ensures that exercise recommendations are achievable and safe. A study by Liao et al. (2020) emphasized the importance of using personalized goal-setting and adaptive feedback to increase adherence to wearable activity tracker programs among older adults. The study found that participants who received personalized guidance reported higher engagement and satisfaction.

Gamification involves incorporating game-like elements, such as points, badges, and leaderboards, to increase motivation. Gamification can make physical activity more enjoyable and encourage long-term participation. Research by Kappen et al. (2017) showed that using gamified features in physical activity apps significantly improved exercise adherence among older adults, especially when combined with social elements like team challenges.

Technology can facilitate social interaction and support by enabling older adults to share their progress, join group challenges, or participate in virtual communities. Social support is a key factor in sustaining motivation and adherence to physical activity programs. Nikitina (2019) found that social group-based interventions, such as virtual gyms, positively affected motivation for exercise and adherence among older adults. Participants who engaged in social challenges reported higher enjoyment and sustained participation.

Encouraging habit formation by integrating exercise into daily routines can foster long-term participation. Technology can support this process by providing reminders, tracking progress, and rewarding consistency. Fritz et al. (2014) discussed how wearable devices help users form exercise habits by delivering consistent feedback and enabling self-monitoring over extended periods.

Using virtual coaching platforms that offer personalized advice from trainers or health professionals can help maintain long-term engagement by addressing specific needs and adapting programs based on feedback. Daniels et al. (2023) demonstrated that using virtual health interventions to coach older adults on physical activity increased adherence rates and enhanced the ability to meet fitness goals.

In conclusion, leveraging technology to engage older adults in physical activity can significantly enhance motivation, adherence to exercise programs, and long-term participation. By integrating features such as personalized feedback, gamification, social support, and virtual coaching, technology can be adapted to meet the unique needs of aging populations.

• Focus on Enjoyable, Socially Interactive Activities
  To increase participation, integrate group activities that promote social interaction and a sense of community. Use wearables to set shared goals or challenges that foster teamwork and social support, which are key motivators for older adults. For example, group step challenges or collective goals can add a fun, collaborative element to fitness sessions.
• Promote Positive Self-Efficacy through Personalized Goal-Setting
  Encourage clients to set realistic, personalized goals based on their current capabilities. This enhances their confidence in achieving these goals and increases engagement. Smart wearables can aid in setting tailored, achievable goals like daily step counts or active minutes, providing immediate feedback that reinforces progress and builds self-efficacy.
• Leverage Wearable Features for Continuous Motivation
  Use wearable features such as daily reminders, badges, and achievement notifications to provide continuous encouragement. Gamification elements—like earning badges or progressing on leaderboards—can transform physical activity into an enjoyable, goal-oriented experience, motivating clients to keep participating.
• Encourage Safe, Age-Appropriate Activities
  Address fears related to injury by using wearable data to monitor health metrics and ensure exercises are performed within safe parameters. Heart rate monitors and step counters can help trainers keep track of clients' exertion levels, reducing anxiety about overexertion and building confidence in their physical capabilities.
• Foster Autonomy through Wearable Customization
  Allow clients to customize their wearable experience, adjusting goals and reminders to suit their preferences. By fostering autonomy, trainers can enhance clients’ intrinsic motivation, making them feel more in control of their fitness journey and more likely to engage consistently.
• Use Simple, Easy-to-Navigate Wearables
  Select devices that offer simplified interfaces with large fonts and intuitive controls to accommodate clients with reduced manual dexterity or vision. This makes wearables accessible and enjoyable for older adults, minimizing frustration and technological anxiety, which can deter continued use.
• Provide Education on Privacy and Data Security
  Educate clients on data privacy practices to alleviate concerns about personal information security. By reassuring them that their data is securely managed, trainers can build trust, enabling clients to use wearable technology without hesitation.
• Highlight Immediate Benefits and Quick Wins
  Emphasize the immediate, daily benefits of physical activity, such as improved mood and increased energy, rather than focusing only on long-term health outcomes. Wearable feedback showing progress in these areas can help clients appreciate the immediate rewards of staying active, reinforcing regular participation.
• Offer Consistent Support and Guidance
  Provide continuous support, especially during the initial stages of using wearables, to help clients feel comfortable with the technology. Regular check-ins, troubleshooting assistance, and guidance on interpreting data can encourage clients to stick with the program and maximize the benefits of their wearables.

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