The Ecological System’s Influence on Physical Activities of Older Adults: Comparison between Older Men and Women

doi:10.21203/rs.3.rs-4321448/v1

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Research Article

The Ecological System’s Influence on Physical Activities of Older Adults: Comparison between Older Men and Women

https://doi.org/10.21203/rs.3.rs-4321448/v1

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Background

Korea is expected to become a super-aged society by 2025. Research has shown that regular participation in physical activity has a positive impact on older adults’ health and reduces national health costs.

Aims

Drawing on Bronfenbrenner’s ecological model, this study examines ecological systems that influence physical activity in older men and women.

Method

The data analysis included information on 537 older adults aged 65 years and older residing in South Korea. The regression analysis identified differences in the ecological systems that influence physical activity in older adults by sex.

Results

By examining the ecological systems that affect physical activity in older men, we found that the macrosystem affected the exosystem (p < .001) and microsystem (p < .001), the exosystem affected the mesosystem (p < .01), and the microsystem affected individuals (p < .001). In the case of older women, the macrosystem affected the exosystem (p < .001), microsystem (p < .001), and individuals (p < .01); the exosystem affected the microsystem (p < .01), and the microsystem affected individuals (p < .001).

Discussion and Conclusion

The results show that interpersonal interactions among friends, family members, and colleagues (microsystem) commonly affect physical activity in older men and women, whereas cultural characteristics that influence belief systems, knowledge, resources, and lifestyle factors (macrosystem) only affect physical activity in older women. These results suggest that older men do not receive sufficient support from the macrosystem in terms of their participation in physical activity. To encourage older men to participate in more physical activities, it is necessary to establish policies that help them form positive values and beliefs about physical activity.

older adults

physical activity

ecological systems

South Korea

In 2018, South Korea (hereafter “Korea”) became an aging society. As of 2023, people aged 65 years or older (hereafter “older adults”) are approximately 18.4% of the total population (51,558,030). Korea is expected to become a super-aged society by 2025, with older adultsaccounting for 20.6% of the population [1].

Such a dramatic change in Korea's demographic structure has sparked greater interest in the healthy lives of older people. At the personal level, older adults’ health significantly impacts their quality of life and happiness. Healthy people can enjoy free and abundant leisure time without pain due to a healthy lifestyle. At the macro level, the health of older adults is closely related to national finances. According to the 2022 National Health Insurance Statistical Yearbook [2], the number of people aged 65 years and older covered by health insurance in 2022 rose to 8.75 million, accounting for 17.0% of the total population. Consequently, total medical expenses for older adults also increased 1.4 times that in 2018, reaching US$ 333.95 billion in 2022.

Physical activity is recommended for the health of older adults. Undoubtedly, regular exercise positively affects their health and effectively reduces the country’s medical costs [3]. However, two out of three Korean older adults do not comply with the World Health Organization’s aerobic physical activity guidelines, and four out of five do not adhere to the strength exercise guidelines [4, 27].

Older men's physical activity participation status is lower than that of their female counterparts. According to the 2023 Korea National Sports Participation Survey (KNSPS), 15.2% of older women do not participate in physical activities, while 17.6% of older men also do not participate, resulting in a high non-participation rate of about 2.6% [3]. By contrast, the proportion of older women actively participating in physical activities was 11.1%, approximately 5.4% higher than that of older men at 5.7%. Consequently, older men's physical activity is lower than their counterparts.

Examining the differences in physical activity levels between older men and women is essential because older adults’ aging and progression differ depending on sex. According to a study by Heo [5], men have poorer health on average than women. Specifically, aging becomes noticeable mainly around 50–55 years for men and 70–75 years for women, and men show faster aging than women until the age of 65 years [5]. In other words, because the aging characteristics of men and women differ depending on the stage of life, physical activity levels and factors affecting them should be analyzed differently [6, 7]. Recently, it has been argued that gender-specific strategies should be developed to increase physical activity participation rates [8]. Studying the aging characteristics of older people is to avoid viewing them as a single group. In other words, factors such as sex, age group, health status, and social stratification based on economic status must be considered.

Several studies have used Bronfenbrenner’s ecological model to multidimensionally analyze systems affecting physical activity in older adults [9, 10, 11, 12, 13, 14]. Bronfenbrenner’s ecological model assumes that human development is influenced by a series of interconnected environmental systems, ranging from the immediate surroundings (e.g., family and friends) to broad societal structures (e.g., culture) [14]. These systems include the microsystem, mesosystem, exosystem, and macrosystem, each influencing different levels of an individual’s growth and development. Microsystems include the individual’s most immediate relationships and environments. For example, older people’s family, friends, and neighbors are part of their microsystem, and the interaction with these people directly influences development. A mesosystem is an interaction between different microsystems, such as immediate family and school and/or work settings. The exosystem includes formal and informal social structures such as government policies, mass media, and community resources. For example, cuts to sports funding from local and central governments can affect older people’s exposure to sports and leisure enrichment. Macrosystems refer to the cultural ideologies, belief systems, and knowledge that affect human development [14]. For example, beliefs about gender roles establish norms and values that permeate an older man or woman’s participation in physical activity.

Previous studies have examined the physical activity of older people as a single group without distinguishing important characteristics such as gender, using Bronfenbrenner's ecological model, which can explain everything from personal to social domains. However, little research has been conducted to empirically analyze whether there are differences in ecological systems that affect physical activity between older men and women.

Therefore, this research aims to examine ecological systems influencing the physical activity of older males and females differently, drawing upon Bronfenbrenner’s ecological model. Following a short introduction, the research is divided into five sections. First, the paper provides a brief outline of Bronfenbrenner’s ecological model and reviews previous research that applied the model. Second, we outline the quantitative method used. Third, analyzing collected data, we look at the differences in ecological systems influencing physical activity between older men and women. Fourth, we discuss the analysis within the socio-cultural context, and finally, we offer a conclusion and considerations for future research.

Theoretical Framework: Bronfenbrenner's ecological model and physical activity of Older adults

Bronfenbrenner's ecological model explains how human development and behavior are influenced by interactions between systems, such as psychological, family, cultural, socioeconomic, and political domains, which ultimately shape our behavior, life decisions, and wellness over a lifetime. In other words, this model of human development connects disparate research fields to explain how individuals and the interplay of their environments contribute to their development [15, 16]. This model asserts that human development is an evolving complex reciprocal interaction frequently occurring over time between individuals, objects, and symbols in their environments. These environmental interactions are referred to as proximal processes, found when one learns new skills or performs complex tasks. Proximal processes aim to explain how individual characteristics and the immediate and distal environments in which the processes unfold result in desired or undesired developmental outcomes. For example, when individuals access and use technology to improve their health, they inevitably depend on the environmental context, such as WiFi accessibility and education or socioeconomic factors. However, they can be further influenced by age and level of computer self-efficacy [17].

Bronfenbrenner's ecological model's basis resides in environmental influences that put the individual at the innermost nested level and expand outward toward larger social systems of influence. The first level of influence involves microsystems. Microsystems include interpersonal interactions among family members, friends, teachers, and colleagues. The second level of influence, mesosystems, comprises the relationships and processes between two or more microsystems, such as interactions between home and school, peer groups and home, and work and home [15]. The next level of influence, exosystems, is the more extensive social system that comprises two or more settings, including direct and indirect components (e.g., politics, economics, and culture). The final level, macrosystems, consists of overarching cultural and subcultural characteristics that influence all other levels, such as belief systems, knowledge, resources, and lifestyle factors.

[Insert Fig. 1 here]

Research that applies the ecological model in the context of sport illustrates how different systems in Bronfenbrenner's ecological model influence an individual’s participation in physical activities. For instance, a study by Zheng et al. [18] found that health inequality exists among older adults in China. More specifically, the lower the income and the worse the community-built environment, the worse the health. The community-built environment plays a vital role in the health of older adults. Moreover, the community-built environment influenced the health of older adults through the intermediary role of outdoor activities and social participation. Kim [9, 10] examined that barriers to physical activity among older people include chronic diseases, a lack of support from social significance such as family members, friends, and colleagues, a lack of sports facilities, and a lack of opportunities to participate in physical activities. These barriers can be categorized into different systems in the ecological model. Backonja et al. [19] asserted that participation in physical activity and intention to continue physical activity among older people involves a wide range of stakeholders: older adults and their families and friends, communities, health services agencies, and government agencies. These involved match the different systems in the ecological model: individual, microsystem, mesosystem, exosystem, and macrosystem. Individuals within each system and in other systems are interconnected. These connections can represent flows of information from local and/or central government agencies (exosystem and macrosystem) about how older adults (individuals) can participate in physical activity and how they create a social network of individuals (mesosystem and microsystem) who share information in choosing a different physical activity.

Bronfenbrenner's ecological model is well-suited to understand older adults' behaviors and attitudes toward participation in physical activities in a super-aging society like Korea. Understanding older people and environmental level factors, interactions, and limitations can guide researchers in designing applications that meet specific personal needs. The study provides a better understanding of ecological systems that affect the physical activity level of older adults by sex and, in turn, contributes to establishing policies on the health and welfare of older adults.

Data

Face-to-face and non-face-to-face surveys were conducted among older adults aged 65 or above living in Korea. The survey comprised 64 questions related to personal characteristics and ecological systems. A total of 537 pieces of data were collected and analyzed. The participant’s characteristics are listed in Table 1.

Table 1

Participants’ characteristics
	Division	Cases	Percent (%)		Division	Cases	Percent (%)
Sex	Male	249	46.4	Smoking	Yes	290	46.9
Sex	Female	288	53.6	Smoking	No	328	53.1
Age	60s	475	88.5	Drinking	Yes	364	67.8
	70s	57	10.6		No	173	32.2
	80 years and older	5	0.9		No	173	32.2
Education	Elementary school	1	0.2	Housing type	Detached house	44	8.2
	Middle school	14	2.6		Apartment	401	74.7
	High school	148	27.6		Multiplex housing	83	15.5
	College	305	56.8		Multiplex housing	83	15.5
	Graduate school or higher	69	12.8		Other	9	1.7
Family type	Single family	69	12.8
	With spouse and children	197	36.7
	With spouse	226	42.1
	With children	45	8.4

[Insert Table 1 here]

The sex distribution of the participants was 249 men (46.4%) and 288 women (53.6%), and the average age was 65.4 years. The number of participants for specific age groups was as follows: 475 (88.5%)—those in their 60s; 57 (10.6%)—those in their 70s; 5 (0.9%)—those aged 80 years and above. Regarding education level, one (0.2%) had graduated from elementary school, 14 (2.6%) completed middle school, 148 (27.6%) had graduated high school, 305 (56.8%) had graduated from university, and 69 (12.8%) had graduated school or higher. Regarding family structure, 69 (12.8%) lived in single-person households, 197 (36.7%) shared their residence with their spouses and children, 226 (42.1%) lived with only their spouses, and 45 (8.4%) were part of their children’s households. 290 (46.7% ) and 364 (67.8%) are smoking and drinking, while 328 (53.1%) and 173 (32.2%) are non-smokers and non-drinkers, respectively. In terms of housing type, detached houses comprised 44 (8.2%), apartments 401 (74.7%), multiplex housing 83 (15.5%) and other 9 (1.7%).

Variables

Table 2 presents the personal characteristics and ecological system factors of the participants used as variables in this study. Personal characteristics of the participants comprised seven questions on sex, age, education level, smoking status, drinking status, family type, and housing type. There are 54 questions related to ecological system factors, including goal content for exercise, social support and social relationships, interaction between microsystems, the sports environment, an age-friendly environment, and collectivism.

Table 2

Description of variables
Division		Variable name	Note
Personal characteristics		sex, age, education, smoking, drinking, family type, housing type	Write and Likert
Ecological system factors	Individual	Goal content for exercise	Five-point Likert
	Micro system	Social support, Social relationship
	Meso system	Interaction between Micro systems
	Exo system	Sports environment
	Macro system	Age-friendly environment, Collectivism

[Insert Table 2 here]

Among factors of ecological systems, the physical activity scale (Goal content for exercise) was used by modifying and supplementing the scale developed by Sebire [20] to suit the purpose of the study. Consequently, a total of four sub-factors and 15 questions were derived as follows: social cognition (3.473), four questions; healthcare (2.871), four questions; social belonging (3.207), four questions; and skill development (2.456), three questions. This scale was found to be reliable in terms of social cognition (α = .941), healthcare (α = .864), social belonging (α = .941), and skill development (α = .896). The Social Support Scale was developed by Sallis et al. [21], and a scale modified and supplemented for Korea by Choi [22] was used. The Social Support (4.265) Scale included one factor and six items, with a reliability of α = .917, which was found to be reliable. The Social Relationship Scale was developed by Weiss [23] and adapted by Kim [24] for Korea. One factor and 10 items were derived for social activities (6.175), with a reliability of α = .927, which was found to be reliable. The Sports Environment Scale was developed by Stahl et al. [25], and the Korean version was developed by Yang et al. [26]. A modified and supplemented version of the scale was used. One factor and six questions were derived for the sports environment (3.637), which was reliable (α = .868). The age-friendly environment scale is based on the age-friendly city guidelines presented by the WHO [27] and constructed by Kim [28], Chung and Park [29], and Chung and Jeong [30]. A total of ten questions for three factors were derived, including five questions on the social environment (3.356), two on the service environment (health and community support services) (1.800), and three on the physical environment (2.097). The level of trust in the social and cultural environment (α = .880), service environment (α = .863), and physical environment (α = .747) were found to be reliable. The collectivism scale used was developed by Triandis and Gelfand [31] and modified and supplemented by Seon [32] to suit Korea. Ten items for one factor of collectivist values (4.796) were derived, which was reliable (α = .875).

Data Analysis

We analyzed the results using statistical methods. Frequency, correlation, and regression analyses were performed using SPSS (WIN 24.0, IBM, New York, US). We conducted a frequency analysis to evaluate participants’ characteristics. Subsequently, factor and reliability analyses were performed to confirm whether the variables were appropriate for the study, and a correlation analysis and regression analysis were conducted to determine the difference in ecological systems influencing physical activity between older men and women.

Ethical Considerations

This research examines ecological systems influencing the physical activity of older men and women, respectively. First and foremost, This study was approved by the Institutional Review Board of Gachon University (No. 2023-020, 22 Mar 2023). Researchers obtained informed consent from all participants before conducting research. We provided detailed information about the study's purposes, procedures, potential risks, and benefits, allowing participants to make an informed decision about participation. Researchers allowed participants to express their right to withdraw from this study at any time. Researchers took steps to protect the privacy and confidentiality of participants' personal information. Data were stored securely and accessed only by authorized personnel. Participants were assured that their data would be anonymized in research publications to protect their identity. Researchers treated participants with respect and dignity throughout the study process, providing appropriate support services if they experienced distress or discomfort during the study.

Results of correlation analysis between sub-factors of ecological system

Table 3 shows the correlation analysis results between the ecological system's subfactors. Specifically, goal content for exercise (social recognition, social affiliation, health management, and skill development), social support, social relationships, sports environment, collectivism, and age-friendly environments (social environment, physical environment, health, and community support services) were correlated.

Table 3

Results of correlation analysis between ecological system factors
	1	2	3	4	5	6	7	8	9	10	11
1	1.000
2	.305**	1.000
3	.025	.366**	1.000
4	.559**	.350**	.115**	1.000
5	.111*	.265**	.296**	.101*	1.000
6	.121**	.486**	.295**	.225**	.231**	1.000
7	.025	.370**	.336**	.138**	.241**	.369**	1.000
8	.041	.320**	.302**	.116**	.197**	.473**	.365**	1.000
9	.148**	.295**	.125**	.187**	.179**	.256**	.498**	.235**	1.000
10	.034	.308**	.371**	.049	.213**	.288**	.480**	.295**	.391**	1.000
11	.087*	.261**	.244**	.128**	.148**	.269**	.450**	.286**	.501**	.427**	1.000
1 = social recognition, 2 = social affiliation, 3 = health management, 4 = skill development, 5 = social support, 6 = social relationship, 7 = sports environment, 8 = collectivism, 9 = social environment, 10 = physical environment, 11 = health and community support service

[Insert Table 3 here]

Analysis of ecological systems influencing physical activity participation in older males

Regression analysis was conducted to determine the mutual influence between ecological systems targeting the older male group aged 65 years or above in Korea. The results are summarized in Table 4. First, macrosystem influenced exosystem (β = .614, p < .001) and microsystem (β = .389, p < .001). Second, the exosystem affected the mesosystem (β = .235, p < .01), and third, the microsystem was found to affect the individuals (β = .287, p < .001).

Table 4

Regression analysis from macrosystem to individual (Male group)
			Estimate(Β)	S.E.	C.R.	p	Estimate(β)
Macro	>	Exo	.986	.081	12.252	***	.614
	>	Meso	− .038	.056	− .688	.492	− .054
	>	Micro	.459	.082	5.596	***	.389
	>	Individual	.191	.103	1.845	.065	.143
Exo	>	Meso	.103	.035	2.986	**	.235
	>	Micro	.096	.052	1.857	.063	.131
	>	Individual	.059	.062	.956	.339	.072
Meso	>	Micro	.179	.094	1.916	.055	.107
	>	Individual	.007	.112	.066	.947	.004
Micro	>	Individual	.323	.075	4.289	***	.287
p < .05, p < .01, **p < .001

[Insert Table 4 here]

Analysis of ecological systems influencing physical activity partipation in older females

A regression analysis was conducted to investigate ecological systems' influence on older females aged 65 years or above in Korea. The results are summarized in Table 5. First, the macrosystem affected the exosystem (β = .582, p < .001), microsystem (β = .364, p < .001), and individuals (β = . 181, p < .01). The exosystem was found to have a significant effect on the microsystem (β = .175, p < .01), and the microsystem was found to have a significant effect on individuals (β = .319, p < .001).

Table 5

Regression analysis from macrosystem to individual (Female group)
			Estimate(Β)	S.E.	C.R.	p	Estimate(β)
Macro	>	Exo	.787	.065	12.127	***	.582
	>	Meso	− .101	.057	-1.776	.076	− .128
	>	Micro	.487	.085	5.713	***	.364
	>	Individual	.205	.077	2.665	**	.181
Exo	>	Meso	.080	.042	1.918	.055	.138
	>	Micro	.173	.063	2.739	**	.175
	>	Individual	.055	.055	1.002	.316	.065
Meso	>	Micro	.011	.088	.126	.900	.007
	>	Individual	− .039	.075	− .519	.604	− .027
Micro	>	Individual	.270	.050	5.355	***	.319
p < .05, p < .01, **p < .001

[Insert Table 5 here]

This study aimed to examine the ecological systems that affect older men's and women's physical activity and to identify differences by sex. As seen in Fig. 2, first, by examining the ecological systems that affect the physical activity of older men, we found that the macrosystem affects the exosystem and microsystem, the exosystem affects the mesosystem, and the microsystem affects individuals. In the case of women, the macrosystem affects the exosystem, microsystem, and individuals; the exosystem affects the microsystem, and the microsystem affects individuals.

[Insert Fig. 2 here]

According to Bronfenbrenner’s ecological model [14], an individual’s development is influenced by a series of interconnected ecological systems, ranging from the surrounding environment to broader social structures. In other words, the physical activity level of older adults is determined by various environmental factors. The results of this study indicate the complex interactions between the different ecological systems.

A particularly noteworthy finding is the importance of the microsystem. The microsystem directly influenced older men's and women's physical activity levels. This result can be interpreted as a positive impact of social support on the physical activity of older men and women. The results of previous studies support the findings in this study [10, 13, 33, 34, 35]. For example, according to a study by Kim [10], who explored strategies to promote physical activity among older adults living in small- and medium-sized cities, a lack of support from people around them led to a decline in their physical activity. This is because people around older adults such as family members and friends are essential information providers with whom they can engage in physical activities [10].

These results have implications for the importance of significant others who directly encourage and support older adults’ physical activities. For older adults, significant others may be a spouse, child or friend, and those living alone may be neighbors. In other words, it refers to the individual that most closely influences their life, and the signifcant others’ interests can lead to an increase in their physical activities. Bronfenbrenner also initially emphasized the importance of the macrosystem but later further emphasized the microsystem, which can directly affect individuals [36].

As the role of significant others becomes increasingly essential, institutional efforts are required to support them. Indeed, Korea has established various policies, such as introducing Long-term Care Insurance and increasing community nursing and medical facilities [37], but these policies are unstable. Long-term Care Insurance reserves are expected to be depleted by 2026, and the system needs to be improved because of the limited number of people receiving care and the low quality of services [38]. In addition, older adults can engage in physical activity at home with their significant others depending on their health level; therefore, it is necessary to provide systematic exercise methods and welfare information to guardians. In addition, alternative measures, such as care for older adults, should be provided more reliably to those without significant others.

Furthermore, while the macrosystem affects older women, it does not affect older men. Based on these results, we could more clearly analyze the causes of low physical activity in older men. Older individuals mainly participate in exercise programs provided by public sports facilities or community welfare centers with low financial burdens [3]. These programs actively promote physical activity among older adults and are operated through government or local government budgets. In other words, as this is a public policy, it requires no personal costs and is easily accessible.

These efforts are part of the macrosystem, including institutions and cultures. Why does the macrosystem, essential for the older adult’s physical activity, affect only women? Senior citizen sports policies seem less influential in helping older men engage in physical activity. According to a study by Yun and Choi [39], the participation rate of older men in exercise programs conducted at senior welfare centers was very low. Most exercise programs are conducted in groups; however, in Korea, the participation rate of older men in programs in which several people exercise together is very low [28].

While the causes of this phenomenon have been extensively analyzed, the cause that has been repeatedly raised is the organization of exercise programs focusing on sports favored by older women [39, 40, 41]. Community exercise programs for older adults mainly include aerobics, yoga, and silver dancing, which limit the participation of older men [39, 40, 41]. However, solving this problem is difficult because of complex institutional and cultural limitations.

Exercise programs require institutional improvements to expand opportunities for older men. However, this is more than just a system that requires improvement. According to Yun and Choi [39], a culture of reluctance to take classes in which many women participate due to social stereotypes about men limits older men’s physical activity. In other words, the unique patriarchal tendencies of Korean men make them hesitant to participate in exercise programs in which many women participate. In particular, the current older generation has preferred patriarchal and conservative masculinity. Therefore, it is difficult to adapt to a group with more women than men, and the tendency to be aware of societal views is prominent.

Therefore, the overall supplementation of the macrosystem is necessary to promote participation in physical activities among older men. This should be followed by institutional and cultural efforts. Institutionally, public sports facilities and economic support for older adults should be expanded so that they can access a wide variety of exercise programs. In addition, we need to identify the sports that older men prefer and provide space for professional leaders in the community to participate. However, cultural initiatives/efforts are also required. Anyone in the community must participate in breaking away from entrenched patriarchal stereotypes and creating a culture that encourages older adults to participate in sports. In addition, rather than operating separate exercise programs for men and women, one solution could be to select and operate sports that do not have gender stereotypes so that they can exercise together.

This study analyzed sociological factors affecting the physical activity of older men and women. Specifically, we determined whether the ecological systems that affect the periodic physical activity of older adults differ depending on sex. Of the responses collected through the online and offline surveys, 537 were used for analysis, and a regression analysis was performed for each sex. The main conclusions are as follows.

First, by examining the ecological systems that affect the physical activity of older men, we found that the macrosystem affected the exosystem and microsystem, the exosystem affected the mesosystem, and the microsystem affected individuals. Second, in the case of women, the macrosystem affected the exosystem, microsystem, and individuals; the exosystem affected the microsystem, and the microsystem affected individuals. In summary, the microsystem commonly affects the physical activity of older men and women, whereas the macrosystem only affects the physical activity of older women. These results suggest that older men do not receive help from the macrosystem.

To address this gap, the community must diversify the types of exercise programs it provides and ease the social atmosphere that restricts sports based on sex. The results of this study may also help establish policies to promote older men’s participation in physical activity.

Author Contribution

Research Design - SYR and IYC ; Methodology - SYR and IYC; Formal analysis - SYR and IYC; Original draft preparation - SYR; Review and editing - IYC. All Authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

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No competing interests reported.

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The Ecological System’s Influence on Physical Activities of Older Adults: Comparison between Older Men and Women

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Abstract

Background

Aims

Method

Results

Discussion and Conclusion

Figures

Introduction

Theoretical Framework: Bronfenbrenner's ecological model and physical activity of Older adults

Materials and Methods

Data

Variables

Data Analysis

Ethical Considerations

Results

Results of correlation analysis between sub-factors of ecological system

Analysis of ecological systems influencing physical activity participation in older males

Analysis of ecological systems influencing physical activity partipation in older females

Discussion

Conclusion

Declarations

Author Contribution

References

Additional Declarations

Status:

Version 1