Abstract
Introduction: Physical activity (PA) guidelines for older adults recommend aerobic activities for 75 minutes at vigorous intensity or 150 minutes at moderate intensity per week or a combination of both. Balance and / or strength training is encouraged at least three times a week, whilst trying to reduce sitting time. In Malta only 28% of persons aged 65+ years reach the recommended World Health Organisation PA guidelines. Malta has one of the lowest prevalence of people meeting PA guidelines across the European region. Retirement is a life event that can influence PA and sedentary behaviour (SB) so can be used as an opportunity to promote positive health behaviours.Research Question, Aims and Objectives: The research questions for this thesis was - Does the retirement transition influence PA and SB in Maltese civil servants; and how can the retirement transition influence these health behaviours? The aim was therefore to measure PA and SB during the retirement transition quantitatively as well as glean data on their experiences qualitatively. To realise the aims, the following objectives were set 1) to identify recent prevalence and trends of PA and SB in the Maltese population pre- and post-retirement, 2) to identify changes in PA and SB resulting with retirement in Maltese civil servants, and 3) to identify predictors of any changes in PA and SB with the retirement transition in Maltese civil servants.
Methods: Four studies were undertaken to address the objectives. The studies included a secondary data analysis of a national data set which examined differences between retired and employed individuals. Thereafter a systematic literature review of barriers and motivators in middle-aged and older persons was compiled. To ensure optimal use, previously validated and reliable tools were translated into Maltese and reliability tested. The last study was a sequential mixed-method (MM) study of civil servant aged ≥60 years, who were followed during their retirement transition for two years. A proportion of the research participants in the MM study retired while the others remained employed. Ethical approval for the study was obtained from Sheffield Hallam University, Coventry University and University of Malta.
Results: Study 1: The secondary data analysis included data from 4690 participants between the ages of 50 and 74 years. Cross-sectional data from 2002, 2008 and 2014 was analysed and there was a statistically significant difference between those employed and retired, with the latter undertaking less physical activity metabolic equivalent min per week (PA MET min per week) in 2002 and 2008. When adjusting for covariates, people in employment carried out less PA MET min per week (OR-0.16 – 0.02) compared to retired individuals. Using multilevel modelling, this study found that individual factors such Body Mass Index and long-standing illness are predictors of PA behaviour as opposed to time trends.
Study 2 - The systematic review included 55 articles, 49 qualitative and 6 quantitative. Analysis was categorised into 50–64-year-olds and 65–70-year-olds with differences in motivators identified between the age groups. In the older age group, social influences, reinforcement, and assistance in managing change were the most identified motivators. In the younger age group, goal-setting, the belief that a physical activity will be beneficial, and social influences were identified as the most important motivators.
Study 3 - The reliability testing of the International Physical Activity Questionnaire – long version (IPAQ-long) and Exercise benefit barrier scale – 2 (EMI-2) found that both tools had similar reliability to the original English versions of the questionnaires. Therefore, they were considered reliable to use for the MM study.
Study 4 - The longitudinal MM study found that there were no changes in total PA and sitting behaviour with retirement in Maltese civil servants. People who retired carried out more domestic PA compared to when they were in employment, which resulted in higher moderate intensity PA behaviour. People perceived that their sitting time would increase with retirement in the qualitative interviews, but this was not found in the quantitative data so there was a disconnect. Past PA behaviour was an important predictor of future PA behaviour, but not for SB. Retirement can reduce barriers towards PA but there were minimal changes in intrinsic motivation with retirement.
Conclusion: This thesis highlights Maltese Civil Servants start discerning about their retirement life before deciding to retire. During the retirement transition, people start planning for activities that will take place after retirement. Participants based much of their post-retirement PA and exercise on past experiences of exercise, not only their current PA behaviour. The person’s perceptions towards PA must be taken into account. On retirement people start adjusting as they either want to be or feel physically active. During the pre-retirement period, there is an awareness on the need to reduce sitting time and yet during the post retirement period sitting time was regarded to be part of the retirement process; concurrently an effort was being made to try and be active.
This thesis provides the foundation for the development of an intervention in Malta to support people during the retirement transition. Interventions which assist retired people to adjust into a routine which includes PA that fits their perception and reduces sedentary activity can be effective. Any intervention which is targeting a behaviour change during the retirement transition must address the retirement process starting at the pre-retirement phase when people are discerning about their retirement. Health behaviours are often considered of secondary importance and yet changes in their PA engagement and patterns will inevitably happen because of retirement. Any intervention needs to consider the retirement transition and not focus solely on health behaviours. Interventions to reduce sitting time might be easier to implement.
| Date of Award | Apr 2023 |
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| Original language | English |
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| Supervisor | David Broom (Supervisor) & Kate Grafton (Supervisor) |