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Eur J Appl Physiol
DOI 10.1007/s00421-007-0392-0
O RI G I NAL ART I C LE
Physical activity and mental well-being in older people
participating in the Better Ageing Project
Kenneth R. Fox · Afroditi Stathi · Jim McKenna ·
Mark G. Davis
Accepted: 3 November 2006
© Springer-Verlag 2007
Abstract Increasing evidence suggests that physical
activity can prevent some aspects of mental illness in
older people such as depression, dementia and Alzhei-
mer’s disease. Additionally, limited research has shown
that engagement in structured exercise can improve
aspects of psychological well-being such as mood and
self-perceptions in older adults. However, the relation-
ship between incidental daily activity such as walking
or time spent sedentary, with psychological well-being
has not been investigated. The Better Ageing Project
provided an opportunity to assess well-being and qual-
ity of life using standardised questionnaires with 176
adults aged 70 and over. Accelerometry was used to
objectively assess daily energy expended in physical
activity at diVerent levels of intensity. In addition, an
assessment of the impact of the 12-month Better Age-
ing structured group exercise programme was assessed
through questionnaires and interviews. Total daily
K. R. Fox (&) · M. G. Davis
Exercise, Nutrition, and Health Sciences,
School of Applied and Community Health Studies,
Centre for Sport, Exercise and Health, University of Bristol,
Tyndall Ave, Bristol, BS8 1TP, UK
e-mail: K.R.Fox@bristol.ac.uk
M. G. Davis
e-mail: Mark.Davis@bristol.ac.uk
A. Stathi
London Sport Institute, Middlesex University,
London, UK
e-mail: A.Stathi@mdx.ac.uk
J. McKenna
Carnegie Faculty of Sport and Education,
Leeds Metropolitan University, Leeds, UK
e-mail: J.McKenna@leedsmet.ac.uk
physical activity energy expenditure (joules/day) and
amount of time spent in activity of at least moderate
intensity were weakly related (r = 0.20–0.28) to quality
of life, subjective well-being and physical self-percep-
tions. Time spent sedentary (min/day) was weakly and
negatively related to several mental health indicators.
The quantitative data showed only minor psychological
beneWts of the exercise intervention. In contrast, inter-
views with 27 research participants and 4 exercise lead-
ers suggested that important improvements in perceived
function and social beneWts had been experienced.
Introduction and background
The recent Chief Medical OYcer’s report in England
(Department of Health 2004) and the World Health
Organisation (World Health Organisation 2002) have
presented convincing evidence for the importance of
regular, moderate intensity physical activity for public
health gain. Reductions in risk arising from regular
physical activity in older age are at least as strong as
those found in middle age for all-cause mortality, car-
diovascular disease, and type-2 diabetes. In older peo-
ple, regular physical activity is also important for the
increase or preservation of muscle strength and power,
maintenance of mobility and independent living, and
prevention and reduction of falls and fractures
(Department of Health 2001; Fiatarone-Singh 2002;
Keysor 2003; Miller et al. 2000; Taylor et al. 2004;
Young and Dinan 2005).
Although the case for physical activity in older
adults has largely been built on its impact on physical
health and function, evidence is emerging for positive
eVects on aspects of mental health. Recent large-scale
123

prospective studies have begun to document important
preventive eVects for mental disorders such as depres-
sion (Strawbridge et al. 2002), cognitive impairment,
dementia and Alzheimer’s disease (Abbott 2004; Col-
combe and Kramer 2003; Laurin et al. 2001; Rovio
et al. 2005; YaVe et al. 2001) in older adults. Addition-
ally, reviews have demonstrated the emergence of a lit-
erature indicating positive eVects of engagement in
activity on various aspects of psychological well-being
in older people (Biddle and Faulkner 2002; Fox and
Stathi 2002; McAuley and Rudolph 1995; Rejeski and
Mihalko 2001) including the treatment of depression
(Barbour and Blumenthal 2005; Blumenthal et al.
1999). Furthermore, it is also likely, although not yet
fully established, that functional Wtness is particularly
critical to mental well-being in older people as commu-
nity mobility is inexorably tied to maintenance of inde-
pendent living (Frank and Patla 2003).
Given the potential of regular physical activity to
improve physical and mental functioning, well-being,
and quality of life, several questions remain about the
nature of the association between activity and mental
well-being. As with all age groups, activity can be cate-
gorised as (1) daily routine activity or ‘lifestyle activity’
such as regular walking or cycling to shops, services and
for leisure, and (2) structured or formal exercise sessions
taking place in sports, community, or residential centres.
Information on the mental beneWts of activity in these
diVerent life contexts is essential for activity promotion
policy development. The literature remains sparse, with
most studies conducted in the USA to investigate the
impact of structured programmes of exercise on mental
well-being (McAuley et al. 2005; Rejeski and Mihalko
2001). In contrast, very little is known about the rela-
tionship between daily physical activity totals, diurnal
and geographical patterns of movement, or time spent
immobile and their association with or impact on mental
health of older people. This is particularly the case for
adults aged 70 and older in Europe.
Measurement poses a major challenge to increasing
our understanding of the activity and mental health
relationship. Attendance at structured and formal
exercise classes can be assessed with reasonable accu-
racy but incidental activity such as short but more fre-
quent walking events is diYcult to remember and
register accurately on self-report tools. Accelerometry
oVers an objective alternative as it can record minute-
by-minute movement including level of intensity. Con-
sequently, energy expended through physical activity
throughout the day, volumes of activity at light, moder-
ate and vigorous intensity levels, and amount of time
spent sedentary can be estimated with improved preci-
sion (Craig et al. 2003; Washburn and Ficker 1999).
123
Eur J Appl Physiol
The European Commission Better Ageing Project
provided our team with a unique opportunity to
address several issues related to physical activity and
mental health in older adults from three diVerent
European countries—Italy, France, and England. The
overall aim of this multi-centre project was to investi-
gate the determinants of frailty in older people with a
particular focus on muscle function, from the cellular
to the functional level. However, the purpose of our
work package was quite diVerent. With very little exist-
ing research with the over 1970s, our aim was to
advance the Weld through the development and exten-
sion of measurement methods for both activity and
mental well-being. In the process we wished to provide
preliminary insight into the links between (1) daily life-
style activity and mental well-being and life quality
indicators, and (2) assess the impact of a structured
exercise programme on mental well-being in the ‘older’
elderly. A mixed-methods quantitative/qualitative
approach was devised that utilised standardised and
new questionnaires, objective measurement of physical
activity, and interviews. This paper provides an over-
view of this research, its objectives, methods, main
Wndings, and implications for subsequent research pro-
jects. SpeciWc objectives were as follows:
1. To assess the reliability and validity of a range of
psychological instruments for the assessment of
aspects of well-being and life quality.
2. To investigate the relationship between daily phys-
ical activity and sedentary living and a range of
indicators of mental well-being and quality of life.
3. To investigate the eVects of a standardised 12-
month programme of structured exercise on indi-
cators of mental well-being and quality of life.
Methods
The Better Ageing project as a whole has been
described more completely elsewhere in this volume and
the detail of the work related to the accelerometry mea-
surement of physical activity is also reported in a sepa-
rate paper (see Davis and Fox, this volume). Ethical
approval for the study was established through MREC
and local ethics committees in the UK, and standard
procedures in Italy and France. All participants pro-
vided signed informed consent to take part in the study.
Participants
Participants were drawn from volunteers at research
sites delivering the Better Ageing exercise programme.
Eur J Appl Physiol
Of the 204 participants recruited, 176 (64/79 controls
and 112/125 intervention) satisfactorily completed
baseline questionnaires. The sites were the University
of Burgundy in France (UB), the University of Pavia in
Italy (UP), and in England the Manchester Metropoli-
tan University (MMU), and King’s College, London
(KC). Participants were invited to take part in the pro-
ject through local advertising. Patients with controlled
disease symptoms were included but those with
advanced neurological, endocrine dysfunction or
uncontrolled disease or pathology were excluded.
Measures and instruments
We aimed to provide a comprehensive proWle of well-
being and quality of life. The challenge was Wnding
instruments that were appropriate and valid for this
age group and that were also available in French, Ital-
ian and English languages. In addition, we wished to
extend the use of two instruments developed by our
team with middle-aged and elderly British populations
that had speciWc relevance to physical activity and
mental well-being.
An extensive literature search identiWed instruments
that were already available in the three languages.
However, these had not been widely administered to
adults aged 70 and above and so were piloted with
English speaking participants. From these, the WHO-
QOL-BREF (De Girolamo et al. 2000; Leplege et al.
2000; WHOQOLGroup 1998), the Satisfaction with
Life Scale (Diener et al. 1985) and the General Well-
Being Schedule (Dupuy 1984) were chosen for the
study. The Ageing Well ProWle (Stathi and Fox 2004;
Stathi et al. 2002) and the short clinical version of the
Physical Self-Perception ProWle (Fox and Corbin 1989)
were translated using the established back translation
method. For example, for the Italian version, the
instrument was Wrst translated by an Italian-speaking
researcher into Italian, tested for face validity with a
group of Italian participants, modiWed and then back-
translated into English using an independent language
expert. Any anomalies with the original version were
then resolved to produce the translated version.
WHOQOL-BREF (WHOQOL)
The World Health Organisation sought a comprehen-
sive instrument capable of assessing quality of life
worldwide. It has therefore been developed through
application in several countries and populations and is
available in 19 languages. This multidimensional
instrument, with items in a Wve point Likert format,
assesses self-rated physical health and function, psy-
chological health, satisfaction with social relationships,
and satisfaction with material/environmental aspects of
life.
Satisfaction with Life Scale (SWLS)
the Satisfaction with Life Scale is a self-administered
questionnaire with Wve non-speciWc items on a seven-
point scale aimed at assessing global life satisfaction
(Diener et al. 1985). It therefore carries no speciWc ref-
erences to diVerent aspects of life and assesses overall
feelings. The SWLS has widely established validity and
reliability including use with older adult populations
(Pavot and Diener 1993; Pavot et al. 1991).
General Well-Being Schedule (GWB)
This instrument was developed by Dupuy (1984) and
translated into several languages by the Mapi Research
Institute, France. The scale reXects positive and nega-
tive feelings in six dimensions that include anxiety,
depression, general health, positive well-being, self-
control, and vitality over the past month. Items are set
in a six choice checklist format.
Ageing Well ProWle (AWP)
This is a multidimensional scale, assessing multiple
aspects of subjective well-being relevant to the physical
activity experiences of older people. Subscales using
items in a Wve-point Likert format measure social
(friendship, support and inclusion), physical (health
and function), developmental (independence, achieve-
ment and challenge) and mental (mood and cognitive
function) are included. The instrument has been sub-
jected to rigorous psychometric development with sev-
eral samples (Stathi 2001; Stathi and Fox 2004)
including conWrmatory factor modelling and has indi-
cated that the subscales are reliable and valid for an
older population in the UK.
Clinical Physical Self-Perception ProWle (CPSPP)
This is a multidimensional proWle designed to provide a
summary of self-evaluations in the physical domain.
The proWle includes three-item subscales in a four-point
structured alternative format to measure perceived
sport competence, physical function, physical strength,
physical health, and body attractiveness. In addition, a
three-item subscale assesses overall physical self-worth.
Developmental work with participants aged 60 and
above has indicated a moderately strong factor struc-
ture and acceptable to good internal consistency.
123

This battery of questionnaires produced a compre-
hensive range of quality of life and mental well-being
outcomes. Global elements such as life satisfaction
were assessed alongside more speciWc elements such as
self-perceptions of physical health or subjective social
well-being.
Physical activity and sedentary living
Physical activity was assessed minute by minute during
waking time over a 7-day period by accelerometry. The
method and procedures are described in detail in
another paper (see Davis and Fox, this volume). Sev-
eral parameters were of interest to this study including
overall physical activity as an indicator of indepen-
dence and daily mobility, amount of activity at higher
levels of intensity that might provide speciWc mental
health beneWts, and amount of time spent sedentary.
For the purpose of these analyses, four summary vari-
ables were therefore extracted. These were: (1) daily
physical activity energy expenditure (PAEE) assessed
in total joules per day, (2) minutes of activity of no
more than light intensity per day (LPA), (3) minutes of
activity of at least moderate intensity per day (MVPA),
and (4) sedentary minutes per day (SED).
Intervention, design, and procedures
The intervention was a standardised exercise pro-
gramme developed by King’s College, London Univer-
sity and involved engagement in two group-training
sessions and one home-based exercise session per week
for a period of 12 months. Each group session lasted
60–90 mins and included warm up, aerobic exercise,
machine-based strength training and Tai Chi and Xexi-
bility exercise.
Intervention and control groups matched on age
were formed at the MMU and KC sites. Randomisa-
tion into intervention and control groups took place
only at the Pavia site. Questionnaires and accelerome-
ters were administered to all intervention and control
participants (1) before the Wrst exercise session, (2)
after 6 months of the intervention (with the exception
of KC participants) and (3) on completion of the inter-
vention at 12 months. One-on-one assistance was avail-
able on each occasion.
Interviews
In order to provide additional information on the per-
ceived beneWts and costs of taking part in the interven-
tion, and provide some indication of factors determining
adherence and dropout, we also conducted 24 individual
123
Eur J Appl Physiol
semi-structured interviews with participants in the Bet-
ter Ageing project. Participants were volunteers at the
UK research sites delivering the Better Ageing exer-
cise programme (Manchester Metropolitan University
[MMU], and King’s College, London [KC]). The exer-
cise classes at the MMU site were delivered in the uni-
versity campus facilities. The exercise classes at the KC
site were oVered in partnership with various health and
Wtness clubs in London.
Participants were purposively selected to provide a
diverse range of experiences from those who com-
pleted the intervention (n = 17), dropped-out (n = 4),
or were in the control group (n = 3). Six interviews
were also conducted with exercise leaders (n = 4) and
Better Ageing researchers (n = 2) from the two cen-
tres. The interviews were undertaken either (1) imme-
diately at the end of the intervention (MMU), (2) 8 or
12 months after the intervention (KC). The interviews
at the MMU took place at the centre where exercise
the programme was delivered. The interviews with the
KC participants took place at their own homes after
the completion of the Better Ageing project in order to
explore further motives and barriers for maintaining a
physically active lifestyle some months after the formal
programme was completed.
A semi-structured phenomenologically driven inter-
view format was chosen to explore in detail the per-
sonal exercise experiences of participants. Interview
schedules were delivered Xexibly, although all topics
were covered in each interview, which lasted 30–
50 min. With respondents’ expressed permission, inter-
views were audio-taped, transcribed in full and
imported into QSR NVivo software (QSR Interna-
tional, 2002).
Analyses
Psychometric analyses including item and principal
components factor analysis and internal consistency
(alpha coeYcients) were Wrst conducted to assess the
performance of the instruments. Descriptive statistics
including means, standard deviations and distributions
for all scales and subscales were calculated by gender
and also as sample totals to provide greater power.
Separate psychometric analyses for English and newly
translated French and Italian versions of the instru-
ments were not possible because sample sizes were too
small to produce robust results.
The associations between mental well-being mea-
sures, physical activity participation and sedentary time
were assessed by Pearson zero-order correlation analy-
sis on data at baseline. This provided an estimate of the
relationship before any eVect of the intervention was
Eur J Appl Physiol

possible. The impact of the exercise intervention on Psychometric properties of instruments

mental well-being was assessed by repeated measures
ANOVA and MANOVA, separately for each gender.
Treatment of the qualitative data was based on the
principles of interpretive phenomenological analysis
(Smith and Osborn 2003). After the free textual analy-
sis in which comments and preliminary interpretations
were prepared independently by the second and third
authors, thematic coding frames were developed for
intervention participants and for intervention profes-
sionals. Connections between emergent themes were
examined and super-ordinate themes interpolated. The
themes from Wrst cases oriented the subsequent analy-
sis of the other cases taking into account convergences
and divergences in the data. The Wrst author then
checked the list of super-ordinate themes for consis-
tency and interpretation and contributed to the transla-
tion of themes into a narrative account.
Results
The Wnal sample with full accelerometry and question-
naire data at baseline were 78 males (m) aged
75.8 § 3.8 years and 98 females (f) aged 75.4 §
4.0 years. At baseline, there were 64 control (m = 26,
f = 38) and 112 intervention (m = 52, f = 60) partici-
pants distributed at four sites in three diVerent coun-
tries (see Table 1). This reduced to 40 control (m = 17,
f = 23) and 92 intervention (m = 41, f = 51) participants
at completion of the intervention period. Six-month
data was not collected at the KC site and there was a
disproportionate loss of control group females so base-
line and 12-month data only were considered for fur-
ther analysis. The majority of participants were
married, educated to at least secondary level and had
no serious conditions of ill-health. Chi-square analysis
revealed no diVerences in these demographics and age
between control and intervention participants for each
period.
These instruments have rarely or never been used
with this population and item, factor and reliability
analyses were Wrst run on data at each time point.
Results from baseline data (n = 176) indicated that
internal consistency of scales and subscales ranged
between alpha = 0.65 and 0.86 making them accept-
able to good. Exploratory factor analysis revealed
that the well-established Satisfaction with Life Scale
produced a single reliable factor. Using the number of
subscales for each instrument to determine factor
numbers extracted, factor solutions produced a high
degree of explained variance in the items (see
Table 2). However, the General Well Being Schedule
and WHOQOL-BREF did not produce clearly deW-
ned factor structures and interpretation of results
using subscales should be tempered with some cau-
tion. The newly developed CPSPP and AWP pro-
vided good internal consistency and, with some minor
exceptions, clear factor structures. As with other
unpublished results, the physical health subscale of
the CPSPP did not form a clear factor and appears to
merge with other subscales, particularly the physical
function subscale. In general, the means and standard
deviations for the 21 psychological subscales across
all instruments were invariant from baseline to
12 months suggesting some degree of stability when
used with groups.
Results were replicated with minor exceptions when
these analyses were conducted separately by gender.
Although small sample sizes did not allow robust sub-
analyses for each language, a preliminary view suggested
similar patterns for each suggesting that translations had
not been detrimental. However, further work with each
language version is required to fully establish reliability
and validity. This early indication of reliability and facto-
rial validity of these established and two new instruments
(CPSPP and AWP), which assess mental well-being prop-
erties particularly pertinent to exercise settings, provide

Table 1 Final sample by gen-

Baseline 6 months 12 months
der, site, and time point
Control Exercise Control Exercise Control Exercise

Site
MMU, UK 26 29 16 29 16 27
KC, UK 15 25 - - 10 20
UB, France 9 31 9 31 7 23
UP, Italy 14 27 14 22 7 22
Gender
Males 26 52 21 43 17 41
Females 38 60 18 49 23 51
Total 64 112 39 82 40 92

123
 Eur J Appl Physiol

Table 2 Results of instrument factor and reliability analyses with both gender combined (baseline data n = 176)
Instrument Factor Factor % Range of
rotation (n) variance subscale alphas

Satisfaction with Llife Scale Direct 1 62.6 0.84

General Well-Being Schedule Oblimen 6 69.4 0.58–0.86
WHOQOL-BREF Oblimen 4 52.7 0.65–0.82
Ageing Well ProWle Oblimen 4 54.1 0.75–0.84
Clinical Physical Self-Perception ProWle Oblimen 5 70.9 0.62–0.81

an important base for further cross-national and
national research with elderly populations.
Relationship between well-being and physical activity
The association of well-being variables at baseline with
various indicators of physical activity and sedentary liv-
ing provided by the objective measure of accelerome-
try was assessed using Pearson correlation analyses.
Baseline data were chosen as it provided the largest
sample and also reXected habitual physical activity of
control and intervention participants before the inter-
vention had commenced. Results for both genders
combined are summarised in Table 3. This produced a
large number of coeYcients for the sample size and
interpretation of the strengths of individual coeYcients
that should be tempered. However, the matrix indi-
cates several consistencies.
Estimations of total daily energy expended by physi-
cal activity PAEE were weakly (r = 0.17–0.24) but con-
sistently related to the composite measures of life
satisfaction, general well-being, quality of life, subjec-
tive well-being, and physical self-perceptions. Closer
scrutiny of the subscale correlations indicates that con-
structs such as ‘psychological health’ (WHOQOL),
‘subjective physical health’ (AWP), ‘perceived physical
function’ and ‘sport competence’ (CPSPP) produce the
stronger coeYcients. Life satisfaction and general well-
being scales produced the weakest correlations. This
would suggest that total movement was therefore

Table 3 Pearson correlation coeYcients for relationships between psychological well-being and total daily activity, time spent seden-
tary and light and moderate intensity activity: males and females combined
PAEE Sedentary time Light intensity Moderate intensity
(Joules/day) (minutes/day) activity (minutes/day) activity (minutes/day)

Satisfaction with life scale 0.17* 0.07 0.06 0.15

WHOQOL-BREF 0.24** ¡0.20* 0.09 0.19*
Physical health 0.20* ¡0.15 0.11 0.22**
Psychological health 0.26** ¡0.16* 0.04 0.21**
Social 0.06 ¡0.19* 0.04 0.08
Environmental 0.21** ¡0.16* 0.05 0.25**
General well-being schedule 0.23** ¡0.09 0.15 0.19*
Anxiety 0.16* ¡0.06 0.11 0.12
Depression 0.18* ¡0.17 0.13 0.20
Well-being 0.10 ¡0.17* 0.01 0.06
Self-control 0.00 ¡0.03 0.02 0.08
Vitality 0.07 ¡0.03 0.02 0.04
Health 0.19* ¡0.05 0.02 0.05
Ageing well proWle 0.22** ¡0.14 0.21** 0.19*
Developmental 0.19* ¡0.17* 0.23** 0.16*
Physical health 0.28** ¡0.12 0.19* 0.23**
Mental 0.13 ¡0.06 0.17* 0.12
Social 0.12 ¡0.09 0.09 0.11
Physical self-perception proWle 0.21** ¡0.17* 0.09 0.17*
Phys self-worth 0.17* ¡0.12 0.13 0.14
Phys function 0.22** ¡0.16* 0.09 0.19*
Phys health 0.13 ¡0.26** 0.15 0.11
Phys strength 0.13 ¡0.14 0.03 0.07
Body attractiveness 0.06 ¡0.01 ¡0.05 0.08
Sport competence 0.21** ¡0.10 0.05 0.16*
PAEE physical activity energy expenditure
*SigniWcant at 0.05, **signiWcant at 0.01

123
Eur J Appl Physiol
related to factors concerned with perceived conWdence
in physical function and capability of being sporty and
is reXected in positive feeling of physical health and
psychological well-being. The amount of time spent in
daily moderate to vigorous physical activity (MVPA)
was small (see Davis and Fox, this volume) but was
also related to quality of life subscales ‘physical health’,
‘psychological health’ and ‘satisfaction with environ-
ment’ (WHOQOL), and ‘subjective physical health’
(AWP). Once again, the SWLS and GWB instruments
produced only very weak relationships. Those who
experience higher levels of moderate intensity physical
activity seem to experience a better quality of life and
perceived health.
Amount of time spent in light intensity activity per
day was not related to any of the life satisfaction, qual-
ity of life, general well-being or physical self-perception
measures. The Ageing Well ProWle ‘developmental
well-being’ and ‘physical health’ subscales produced
weak correlations but there is no obvious explanation
for this.
As predicted, the amount of time per day spent sed-
entary produced negative correlations with several psy-
chological health indicators. Quality of life for those
most sedentary was lower and their perceived physical
health and function was lower.
Although these correlations are not strong, they
provide some indication that older people who move
more often and more intensively and/or spend less time
sitting during the day perceive higher levels of mental
well-being and life quality. Daily mobility, either as a
consequence, or determinant, of psychological well-
being seems important for older people and deserves
greater research attention.
Intervention eVects: evidence from questionnaires
The Better Ageing exercise programme achieved a
93% attendance rate, as assessed by records kept by
the exercise leader at each site. Self-reported compli-
ance to the recommended home-based sessions per
week was 85%. This is an unusually high commitment,
and perhaps particularly surprising for a population of
this age. Gender distribution at baseline and 12 months
was not signiWcantly diVerent. However, there were
signiWcant diVerences in well-being variables scores
between intervention and control group males at base-
line on 12 out of 21 subscales. Intervention group par-
ticipants scored higher on general and physical health
and well-being variables than controls. No baseline
diVerences existed for females. There was a diVerential
1980s to loss of the over 80 year old males throughout
the programme. Because of lack of power, we used a
repeated-measures ANOVA with the composite scale
score for those instruments whose factor structure had
not been well deWned in earlier analyses (WHOQOL-
BREF, GWB) and also the uni-dimensional SWLS.
Repeated measures MANOVA was used for proWles
with clear subscale deWnition (AWP and CPSPP). Bon-
ferroni adjustment was applied. Results indicated only
one signiWcant change with all instrument means show-
ing remarkable stability over a 12-month period. There
was a signiWcant group £ time interaction for male in
physical self-perception proWles (CPSPP) (F[1,52] =
8.938; P = 0.004). This was explained by the control
group deteriorating in proWle scores and the interven-
tion group remaining the same over the time period of
the intervention. The WHOQOL-BREF and AWP for
males and females showed small diVerences in favour
of the intervention group but did not reach signiW-
cance. Overall, these results suggest that the exercise
intervention did not create large improvements in
mental well-being and quality of life, although there
are suggestions that it may have prevented a decline in
physical self-perceptions in men.
Intervention eVects: evidence from interviews
Interviews were conducted to provide further informa-
tion on (1) the eVect of the intervention on the well-
being of participants, and (2) factors determining
adherence to, and dropout from, the programme and
exercise in general. A summary of typical and illustra-
tive comments on the eVects of the intervention on
aVect, self-perceptions and social well-being are pre-
sented here.1
Outcome expectations
There was clear evidence that participants entered the
programme with a set of positive expectations about
the potential beneWts of the programme. These beneWts
were seen as mainly physical rather than mental. Post-
poning physical deterioration was seen as a primary
reason for taking part in the programme. Those with
previous exercise experience in particular, expected
Wtness improvements, better mobility and ability to
perform everyday activities and weight loss.
I was interested in getting Wtter. (Karen, 74)
I thought, I’ll take step in advance and go on the
falls programme before I begin to fall. That was
why I volunteered to take part. (Karl, 87)
1
Real names have been replaced with pseudonyms which are
followed by the real age of the participants.
123

Physical self-perceptions
Participants reported that early in the programme they
began to notice Wtness improvement in areas such as
strength, Xexibility and general mobility which they felt
had led to better functionality and performance in their
everyday activities.
I never used to walk anywhere and now I walk at
least an hour everyday. (Susan, 74)
I get out of bed easier. Hoovering is so easy you
just walk up and down much better. Because
those were the movements that came into the
exercise—the walking and the pushing. (Helen, p.
73)
Some participants appreciated the strong focus of the
intervention on strength and coordination and they
commented on the appropriateness and eVectiveness
of exercises tailored to their functional needs.
I’ve got arthritis in my left foot. It always gave me
trouble. Since I’ve been going to the gym, it’s deW-
nitely helped me by strengthening my leg up.
(Alex, p. 75)
Participants felt that strength training provided direct
feedback and within a short period of time allowed
them to see their improvement. This provided chal-
lenge and a sense of achievement and was a strong
motive for them to work hard.
The machines are better. Well they seem to need
more eVort and I think they increase your
strength. The bands just keep your strength at the
same level I think (Helen, p. 73)
For some, this sense of achievement seemed to gener-
alise beyond the exercise setting to more global levels
of self-worth.
I’m more contented with my own self. It’s every
time I’ve been and I walk back across that yard I
feel that I’ve achieved something that I’ve got a
little bit stronger I’m more Xexible. I’m not a fail-
ure. That’s the way I feel about it. (Colin, p. 73)
Connectedness and social support
There is evidence from the interviews that social well-
being was experienced through support and interac-
tion. Part of the enjoyment experienced in class was
clearly the quality of relationships and environment
created through a high standard of leadership exper-
tise and support. Participants commented on the
knowledge, the patience and the enthusiasm of both
123
Eur J Appl Physiol
the researchers and the class leaders. They praised
the support they received especially during the Wrst
sessions, which they felt was the most diYcult time for
them.
We have had good people teaching this. They had
a super team and there isn’t one of them who has
not been nice to us you know and they’re great,
all of them have been super. It all helps doesn’t
it? If you get someone—an instructor—someone
who you didn’t like, he was bit nasty, you
wouldn’t want to come would you. When they are
all so nice and welcoming they bring out the best
in you, hopefully. (Mary, p. 71)
The use of intensive tuition and one-on-one support
during the Wrst weeks of the programme enabled staV
to provide reassurance and help participants build both
conWdence and physical competence to cope with the
exercise loading.
I watch each individual as we are doing the aero-
bics—see how they’re coping with it... you see the
exertion in the face... I’ll announce to everybody,
‘If you’re Wnding this one hard, this is what you
can do. (A, exercise leader)
Some participants also mentioned that they appreci-
ated the attitude of the leaders who they felt had
treated them with respect, especially regarding their
age, and had made them feel valued. Exercise profes-
sionals were sensitive to the importance of mutual
inter-generational empathy.
We have never been talked down at. We have
been encouraged and we have been entertained
and I think they’ve been entertained and I would
regard them as friends.
One person said to me the other day that he used
to think that young people sort of looked down
on them. I can remember the exact words he
used. But after working with our group, he had
more faith then in the younger generation. (J,
Researcher)
The positive social interaction provided by the
group-based exercise was a primary source of enjoy-
ment and an important reason to attend. Comparing
the two components of the exercise programme, the
group exercise and the individual home-based exercise,
participants reported a clear preference for the group
activity.
Several participants described the home-based pro-
gramme as boring and providing little motivation. In
contrast, the exercise group setting oVered a friendly
Eur J Appl Physiol
and supportive environment with opportunities for
socialisation.
DeWnitely the class was better because of the
other people there as well. (Mary, 71)
It was lovely to meet up with everyone twice a
week, whenever we were all there. It was very
nice. It broke down the barrier eventually to
being nervous of going to the gym, because one
has this idea of everyone being in their slinky leo-
tards, fantastic gear and everything. (Margaret,
70)
Support and positive reactions from signiWcant oth-
ers such as family and friends also seemed to be impor-
tant for some participants.
My family think it’s absolutely brilliant.
(Rebecca, 75)
My two sons were amazed that their retired father
still had the energy to have a go at something and
my wife was delighted as she felt that I wasn’t get-
ting enough exercise anyway. (Martin, 75)
Enjoyment
Participants, including dropouts, reported that the
exercise classes had been an enjoyable experience. The
creation of a welcoming and social atmosphere was
particularly important. The only unpleasant elements
mentioned by some participants were concerned with
the discomfort of some of the research tests.
I think we enjoyed everything about it you know
and various little things cropped up at diVerent
times which could make you laugh. (Ray, 75)
it was really fun, everybody knew everybody else.
(Charlotte, 74);
The second time I enjoyed it so much I wanted to
come again. (Mary, 73)
Empowerment and energising eVects
The exercise classes were used by some participants as
a way to escape falling into lethargic routines.
I’m sure if I stayed here, and didn’t take any exer-
cise, my mental state would be very poor. But
going about, doing that, and having the incentive
to go out every day, is good for the mental thing.
(Susan, 74)
For some this was expressed in a sense of increased
energy and motivation in other aspects of their lives.
Now I’ve got to the stage, where if I don’t go out,
I don’t feel right—which for me is amazing.
Before, weekends were just spent working and
catching up on sleep I hadn’t had in the week,
from getting up at 4:45. Friday afternoon, would
come in and shut the door, and wouldn’t go out
till Monday morning. Now if I don’t go out in the
weekend I feel weird. (Susan, 74)
Altruism
A factor that had not previously been considered
emerged from the interviews.
Engagement in the research project had provided an
opportunity for altruism.
What we decided was that this was obviously
putting something back into medical science and
we’ve had quite a bit out of it over our years so it
was a means of putting something back in. (Jack,
73)
There were strong feelings that it had provided a
chance for “pay back” to the community. To some
extent, acting as a research participant was seen as a
social duty and this allowed them to endure some of
the less enjoyable research tests involving electrical
stimulation and CT scanning.
I have enjoyed it all, even the twitches that are
confusing, the electric shocks which are not pleas-
ant. But I would go through it again, it would not
put me oV. (Mary, 71)
Few minor negative outcomes were reported and
this is reXected in high attendance and low dropout
from the programme. Furthermore, serious health
problems or important family commitments rather
than a problem with the programme were the main
reasons for the very few participants who dropped-out.
Last December my brother was diagnosed with
cancer and he’s very ill—that was the reason I
dropped out. (Sandra, 75)
In summary, there is clear evidence from the inter-
views with participants and exercise leaders that physi-
cal and mental beneWts were experienced in the Better
Ageing exercise programme. Most of these beneWts
arose from attendance in the group exercise sessions.
For a variety of reasons, these were seen as enjoyable.
The activities and interactions themselves were gener-
ally seen as a lot of fun. They provided an opportunity
to experience high quality social interactions with exer-
cise specialists and also with people with similar inter-
ests and needs. They produced a sense of improved
123

physical competence through increases in strength,
general Wtness, and ability to perform tasks of daily liv-
ing. They also provided opportunities to feel that a
worthwhile eVort had been made to counteract the
ageing process. For some, it also seemed important
that this produced positive reactions from family and
friends. These Wndings have been seen elsewhere in
group-activity programmes for older people (Cattan
et al. 2005; McAuley et al. 2000a, 2000b; Stathi et al.
2002, 2003). The degree to which these positive speciWc
outcomes translated into higher order aspects of well-
being such as self-esteem or self-determination is diY-
cult to conclude from these data.
Discussion
This research has provided an important opportunity
to apply and develop methods to assess psychological
well-being and physical activity with this under-studied
but growing population of European adults over the
age of 70. Administration of a battery of instruments in
three languages demonstrated the feasibility of ques-
tionnaire data collection with this population that
included adults up to the age of 86. Psychometric anal-
yses of instruments indicated that they generally pro-
duced meaningful results with adequate reliability.
Sample size did not allow robust analyses of versions in
each language but overall results appeared similar.
However, factor analyses suggested that the multidi-
mensionality of two standard instruments—the WHO-
QOL and general well-being schedule, was not clearly
established and individual subscales or sub-dimensions
were not all well deWned. On the other hand, the new
shorter version of the physical self-perception proWle
and the Ageing Well ProWle produced sounder factor
structures and good reliability. These instruments are
purpose-designed for use in the physical activity setting
and oVer a valuable base for further cross national
research. This is already underway with data collec-
tions in Italy and the UK.
To our knowledge, mental well-being parameters
have not been previously set alongside objective mea-
surement of daily physical activity with this age group.
Previous data have relied on self-report and almost all
studies have addressed the activity/mental health rela-
tionship in the context of structured group exercise.
Little is known about the impact of volume of energy
expended or higher intensity daily activity through
physical activity. Findings indicated that there was a
consistent positive but weak relationship between sev-
eral indicators of perceived health, physical function,
and self-perceptions with total volume of activity, and
123
Eur J Appl Physiol
activity of at least moderate intensity. Conversely,
weak negative relationship emerged with amount of
time spent in a sedentary mode. Older people in this
study, who move more often and spend less time sitting
down, experience higher levels of self-rated mental
health and well-being than those who are less active.
Both causal directions for this relationship are plau-
sible and likely. High total amounts of activity and
achievement of greater amounts of moderate intensity
activity may have contributed to higher levels of men-
tal well-being. However, it is equally possible that
those with higher levels of mental well-being and per-
ceived health are more capable and motivated to be
active on a daily basis. Randomised controlled studies
will be needed to address dominant directions of this
causality. Accelerometry provides a viable means of
documenting the eVectiveness of interventions to
increase daily activity and provides a sounder basis for
investigating its consequences for psychological well-
being.
This study also oVered a preliminary opportunity
to investigate the eVects of a 12-month structured
group exercise programme on psychological well-
being. Results from questionnaires produced at best,
inconsistent evidence of a beneWcial eVect of exercise
for men. These small changes in only a few measures
of mental well-being across the intervention period
were unconvincing and it is not possible to conWrm
substantial positive changes in well-being as an out-
come of the programme. However, the research
design did not allow a deWnitive trial. Recruitment
and statistical power were determined by the
demands of the key physiological research questions
in the Better Ageing project. Participants were not
randomised at three sites and matched-controlling failed
to produce equivalence in the initial psychological
proWles of the males.
Recruitment of a representative sample to studies
involving physical activity interventions poses a partic-
ular challenge with this population. Consenting volun-
teers tend to be Wtter, more physically able, better
educated, socially aware and mentally healthier than
average. Although there were no diVerences between
control and intervention participants in age, educa-
tional, marital or health status, it is possible that the
weak quantitative Wndings were at least in part a result
of participants already experiencing high levels of men-
tal well-being. The qualitative approach in this
research has conWrmed a strong commitment in partici-
pants to contributing to research among participants.
This is reXected in very high attendance and low drop-
out rates and it might have produced inXated baseline
scores.
Eur J Appl Physiol
In contrast, to the results from standardised ques-
tionnaires, the data from interviews with participants
suggest that important mental beneWts were experi-
enced by many participants as a result of the interven-
tion. These included enjoyment of the sessions that
led to improved mood, improved physical self-percep-
tions of strength, Wtness and ability to function better
in the tasks of daily living. Social beneWts were com-
monly reported as a result of the quality of the exer-
cise environment and the opportunity for interaction
that it provided. It is possible that the group of partic-
ipants volunteering for interview may have been a
select group of particularly enthusiastic individuals
but their comments were also reXected in responses
from exercise leaders and researchers. The anomaly
between quantitative and qualitative results could be
explained by a lack of power for psychological out-
come variables or a shortfall in sensitivity to detect
diVerences in people who may already be in the
higher percentiles of well-being on measures. At this
point, it is not possible to fully determine which of
these is the case.
This research has provided important groundwork
for future research concerning physical activity in the
over 70s. It has provided some preliminary evidence of
reliability of instruments able to assess aspects of psy-
chological well-being and life quality. This includes two
new instruments to assess exercise-related subjective
well-being and self-perceptions. However, more work
is required to fully establish the properties of the Age-
ing Well ProWle and the Clinical Physical Self Percep-
tion ProWle in diVerent languages. The WHOQOL-
OLD is a new 24-item 6-facet measure designed to
assess sensory abilities, autonomy, past, present and
future activities, social participation, death and dying,
and intimacy which can be used in conjunction with the
WHOQOL-BREF for assessment of quality of life in
older adults (Power et al. 2005).
Accelerometry emerged as a feasible method for
assessing daily physical activity levels which has previ-
ously not been attempted with this age group. The
stronger and more consistent associations with physical
activity were with physical self-perceptions and per-
ceived health and well-being. Future studies should
assess physical function, degree of disability and ill-
health, and body-weight related variables to determine
the extent to which they mediate the activity/well-
being relationship.
Acknowledgements This study was supported by the European
Commission Framework V fund (‘Better-Ageing’ Project No
QLRT-2001-00323). The authors wish to thank Dr Lijung Chen
for her assistance with statistical analyses
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