Introduction

The health and wellbeing of the ageing population has become one of the most significant global challenges [1]. The 2019 Revision of World Population Prospects estimates that by 2050, one in six individuals will be aged above 65 years: an increase from one in eleven in 2019. Also, the number of individuals aged 80 years or over will triple [2]. However, this increase in life expectancy is not correlated with a rise in quality of life and health, as functional losses, psychological impairment and loneliness increase with age [3–5]. Subsequently, medical costs to treat age-related conditions and illnesses generate the highest financial burden for the majority of nations around the world [3]. To lower healthcare expenditure, it is essential to help older adults maintain their independence and an active lifestyle to promote mental and physical health [6–8]. Recommendations from the World Health Organization (WHO) state that older adults should engage in 150–300 minutes per week of moderate intensity activity or 75–150 minutes per week of vigorous intensity activity, or some equal combination of moderate and vigorous intensity aerobic activity, and on two or more days per week, do muscle-strengthening activity (such as strength and resistance training) to promote health and well-being [9]. However, current estimates indicate that only two in five (39%) individuals aged 75 years and above were active in comparison with 7 in 10 (69%) 16 to 24 year olds [10].

Moderate-to-vigorous physical activity (PA) is an essential behaviour for promoting health and well-being at all ages [11–14] where a substantive body of evidence demonstrates beneficial effects for physical and mental health and well-being [13, 15–17]. It is estimated that a greater level of PA reduces the risk of type 2 diabetes by up to 40%, of cardiovascular disease by up to 35%, of depression and falls by up to 30%, of back and joint pain by up to 25% and of breast and colon cancer by up to 20% [18]. Moreover, a number of PA based interventions (exercise and walking), for falls prevention [19], slowing cognitive decline [20], and balance improvement [21] have shown promising results in randomised clinical trials (RCTs) and systematic reviews. Hence there is compelling evidence to support the promotion of PA for health in adults [22].

Sedentary behaviour (SB), especially when associated with extended durations of sitting, is also a risk behaviour [23]. SB is defined as any waking behaviour exemplified by an expenditure of energy less than or equal to 1.5 metabolic equivalents (METs), when in a sitting, lying or reclining posture (for example, watching television; [24, 25]. SB is prevalent throughout the population, but older adults have been found to be the most sedentary group in the population [26, 27]. Their total of 10 to 14 hours on average of sitting per day places them at a significantly higher risk for developing various non-communicable diseases [28–30]. In contrast, people who minimize their level of SB seem more likely to have improved quality of life [31, 32]. For instance, lower sitting time was related to higher global physical health (GPH) and global mental health (GMH) scores among less sedentary older adults [33]. Similarly higher well-being (positive affect) was strongly related to more PA and less sitting time [34].

Research on older adults found that they spend 70.1% of their time being sedentary at home [35], suggesting that the home environment has a significant impact on older adults’ PA and SB. According to research, the physical home environment can act as a both an enabler and a barrier to older adults’ PA and SB [36–38]. Regardless of the significance of the physical environment of the home, it was also noted that the home environment is socially influenced by the individuals who live there; making the home a dynamic ecological setting [39]. Given this potential diversity of factors influencing PA and SB in the home environment, a useful model for advancing our understanding of older adults’ PA and SB is the socio-ecological model [40]. This model highlights the importance of human-environment interactions as key influencing variables on behaviour [40, 41]. Five levels of influence are suggested by this model: individual traits; age, and motivations, interpersonal variables; family and friends, organisational factors; healthcare institutes, community factors; societal norms, and policy-level factors; laws and policies [40].

The home has great significance in relation to PA and SB as it is the one place that people may control, can express their personal identity, experience autonomy, safety and privacy and which influences the activity level that the individual performs during their daily routines [42, 43]. The home environment in our study refers to the microenvironment within which individuals are residing [44, 45]. Most research has focused on the urban neighbourhood at the organisational level for the SEM, highlighting accessibility to locations, amenities, and services such as recreational opportunities, and public transport, as an important factor for PA [45–51]. Whilst these are significant determinants, they do not account for the microenvironment that the majority of older adults live in and spend the majority of their time [52]. According to a global report of 10 nations [42], the majority of older adults reside independently in their communities rather than in more supported environments (e.g., care facilities or communal residences). Indeed, the majority of older adults (≥ 65 years) in the UK live alone within their indoor home environment [42, 53]. This signifies the importance of making the home environment conducive for older adults to enhance their PA engagement and minimize their SB, in accordance with the diverse layers of the SEM [54].

Given that older adults spend the majority of their time being sedentary at home [35], the indoor home setting is therefore an important context to understand. It has, however, received limited research attention but is a key subject for investigation in PA [55–59] and SB research [35, 54]. Those research studies that have explored the relationship between the home environment and PA and SB have mainly focused on space within the home and garden, fittings and fixtures (stairs, kitchen and bathroom space) to understand older adults’ PA patterns in their home environment [55–59]. However, these studies failed to assess barriers and facilitators to PA and SB using all the levels of SEM that include individual, interpersonal, organisational, community and policy-level factors. As older adults become increasingly dependent on their personal environment, to support their PA, the home and factors associated with it become strong determinants of their PA and SB [42]. Therefore, the primary aim of the present study was to understand the influences on older adults’ PA and SB within the home environment, using the SEM as a theoretical framework. In doing so, this qualitative research will determine the barriers to, and facilitators of, older adults’ PA and SB in their home environments.

Material and methods

Data collection procedure

The study was approved by an institutional Research Ethics Committee (REC: NM_31-03-22), and following this, interviews were conducted by the primary researcher (NA) at a suitable time for the older adult and upon gaining the older adult’s written consent. A semi-structured interview guide was developed (see S1 File Interview guide) based on the SEM [60] with particular emphasis on the home environment. The guide also covered several factors at different layers of the SEM to explore their effect on older adults’ PA and SB. These include individual-level factors (self-motivation, attitude and motivation), interpersonal level factors (family and friends), organisational level factors (healthcare institutes), community level factors (social groups), physical environment (significance of the home and garden space, physical equipment, electronic media equipment and changing infrastructure within the home) and policy level factors (influence of lockdown, and role of healthcare system). Study participants were questioned about personal, family and community roles in PA and SB, about their home environment itself, including what they like about their home setting, how it was chosen, what kind of physical activities they performed within the home environment, use of garden space and stairs and how the home environment had been or could be altered to promote more PA and reduce SB. Older adults were also asked about the presence of PA equipment within their home and its frequency of use. Following this they were questioned about community services, healthcare services, the role of technology and impact of COVID-19 pandemic on their activity levels. In addition, socio-demographic data (age, gender, level of education, occupation level, ethnicity, and marital status) were collected.

Firstly, all IDIs (n = 33) were conducted online and lasted between 30–40 minutes. Next, FGDs (n = 5) were conducted face-to-face with participants who had not taken part in the IDIs. FGDs were carried out in a private room in a community hall where the religious and community groups met and lasted between 50 and 60 minutes. The male and female distribution for IDIs and FGDs is shown in Table 1. Data collection ceased once data saturation was achieved.

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Table 1. Study participants who participated in in-depth interviews and focus group discussions.

https://doi.org/10.1371/journal.pone.0294715.t001

Results

The mean age of participants was 71.7 ± 5.2 years (57.1% females). On average 39.0% of older adults spent more than two hours a day watching TV, while 84.5% spent more than two hours a day on their mobile phone, computer/laptop or the internet for leisure. A high percentage (79.5%) had a university degree.

Due to the absence of data on income and SES, the 2019 Welsh Index of Multiple Deprivation scores calculated from postcodes were used as a measure of socioeconomic status (SES). Eight areas of deprivation are taken into account when calculating the WIMD scores: health, employment, housing, income, community safety, education, access to services, and the environment [64]. Resulting scores range from 1–1909, with 1909 being the least deprived and 1 the most deprived. Based on the WIMD score, participants were divided into SES tertiles: low-SES (1–636), medium-SES (637–1272), and high-SES (1273–1909) groups as used previously [65]. Based on WIMD scores, 16% of the older adults were categorised as low-SES, 35% as medium-SES and 49% as high-SES. The remaining socio-demographic characteristics of the older adults are provided in Table 2.

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Table 2. Characteristics of study participants (n = 49).

https://doi.org/10.1371/journal.pone.0294715.t002

The subthemes that were identified within the deductive themes derived from the SEM 1) Individual level: Attitude, perception and motivation 2) Interpersonal level: Family and Friends: a motive to remain active 3) Organisational level: healthcare institutes, 4) Community level factors: Significance of social groups, 5) Physical Environment: Microenvironment and 6) Policy level factors (lockdown restrictions and healthcare system). are presented in Table 3.

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Table 3. Themes, subthemes and quotations of study participants.

https://doi.org/10.1371/journal.pone.0294715.t003

Discussion

This study explored older adults’ perception of their home environment and its impact on their PA and SB using the SEM as a theoretical framework. The findings indicate that several factors at different levels of the SEM had an impact on older adults’ PA and SB. These include: 1) Individual level: Attitude, perception and motivation 2) Interpersonal level: Family and Friends: a motive to remain active 3) Organisational level: healthcare institutes, 4) Community level factors: Significance of social groups, 5) Physical Environment: Microenvironment and 6) Policy level factors (lockdown restrictions and healthcare system) impacting older adults’ PA and SB at home.

Within the individual level of the SEM model factors such as being lazy, poor health or belief that being physically active was a crucial component of independence all contributed to older adults’ PA and SB in their homes. Existing activity habits and the development of activity routines within the home environment have been noted to be significant drivers of participating in PA in older adults [66, 67]. Moreover, awareness of the mental and physical health benefits of being physically active can motivate older adults to remain active and moving, whereas poor health can act as an obstacle. This supports previous findings on how to encourage older adults to be physically active [67–69]. In addition, positive views on ageing also foster PA among older adults despite their poor health. This finding parallels those of earlier studies showing that older adults with positive self-perceptions of ageing engaged in more PA such as walking and playing sports [70, 71]. In addition, it was also noted that older adults with poorer health who had positive perceptions of ageing walked the same amount as with good health [70]. Hence underscore the importance of positive perceptions and extend understanding of how they also influence home-based PA and SB.

The current findings illustrate the dynamic nature of the home and the interactive effect of different factors at all levels of the SEM on older adults’ PA and SB, which is consistent with prior research [72–74]. The physical environment of the home can act as both a hindrance to, and facilitator of, PA and SB, however, as shown in earlier research [77, 79], our findings indicate that the family within the home modifies the environment dynamics. This was clearly evident in our findings as families were sometimes responsible for making or restricting modifications that helped or hindered these older adults’ PA and SB at home. In addition, different home social environments, such as living with family or alone can act as either an enabler and barrier to PA and SB. This is in line with a systematic review that suggested that family is the most crucial factor to take into account when examining sedentary pattern and PA behaviour and attitudes [75]. Moreover, prior research found that grandchildren engaging older adults in PA has been strongly linked with higher activity levels [76, 77]. Similarly, in the present study, spending quality time with grandchildren appeared to enhance older adults’ PA and minimize their SB through structured and unstructured play, which has numerous advantages for older adults’ physical, mental, and social wellness [77].

The social component of participating in activities is therefore a key motivator for maintaining PA and minimizing SB within the home environment and engaging in group activities helps to build and maintain relationships with others. Previous research studies [78–80] have highlighted that having opportunities for making social connections with friends encourages older adults’ participation in physical activities. However, in our study, many Muslim female older adults emphasized the need for culture sensitive social groups. Similarly, in previous research it was identified that Muslim women are discouraged from participating in mixed gender activities because of personal or familial gender-based expectations and modesty [81]. Therefore, our findings reinforce earlier suggestions that social facilities that are consistent with the cultural beliefs and practises of these groups must be provided to ensure the involvement of diverse communities [81, 82]. Doing so can offer an incentive for these older adults to be active in their homes as a platform to engaging in community-based physical activities.

At the organizational level healthcare institutes play a significant role in encouraging older adults to be physically active and avoid SB within their home. Evidence shows that motivation is a crucial driving force for older adults to participate in physical activity and increase their participation in PA programs [83]. Current findings showed many older adults feel motivated and completed exercises when they were prescribed by healthcare professionals and accounted for their physical limitations and abilities. Literature also suggests that the most effective way to spread strategies is through health care professionals, who can offer guidance and motivation on what to do based on the health status of each older person [84]. Therefore, healthcare organizations should motivate healthcare professions to adopt this culture of being advocates for PA and reducing SB as this could play a significant role in improving the attitudes of older people toward active living in their homes and daily routines.

The indoor or microenvironment also plays a key role in older adults’ PA and SB. It was found that large spaces within the home environment, such as spacious rooms and a garden, enabled older adults to perform different kinds of physical activities. This study finding is consistent with the literature emphasizing that homes with broader corridors along with multiple rooms or clearly defined spaces facilitated activity among older adults [59]. In addition, it has been reported that outdoor space (i.e., a garden) was associated with the highest levels of PA and self-reported physical health among older adults [85]. This enabled them to expend varied amounts of energy, based on the compendium of PA for metabolic equivalent (MET) intensity levels [86]. Hence making the home conducive to promote transition (sit-to-stand), as highlighted in the 24-Hour Movement guidelines that emphasize the need to reduce SB to ≤ 8 hours [54]. Moreover, the ability of individuals to directly manage key aspects of the physical environment within the home appears to set the home apart from other settings that aim to encourage individuals to be physically active. This finding illustrates the importance of the person-environment interaction, as espoused by a SEM approach, in influencing behaviour, in this case, PA and SB [87].

The possession of PA equipment, along with its accessibility, was another significant factor within the home. The availability of environmental and PA resources can enhance the likelihood of individuals performing PA and act as an initial step in meeting the recommended level of PA [88, 89]. Accessibility is associated with the feasibility of use and cueing of behaviour, as activity or exercise equipment that is instantly available with convenient access requires less effort to use compared with that which is less conveniently located [90], making this a crucial factor for PA. However, family members often moved equipment to an inaccessible place within the home environment, thus decreasing older adults’ PA at home environment. This highlighted that various factors at different levels of the SEM interact within the home physical environment to influence older adults’ SB and PA behaviour. Further, there is a strong connection between physical and social environments [39, 91], which may act synergistically causing an impact on the individual’s behaviour [39]. Therefore, it is arbitrary or illogical to separate physical and social aspects of the environment [92].

Electronic media use within the home environment plays a significant role in older adults’ PA and SB. Many older adults in this study spend a substantial amount of time on social media though they realized that this could have implications for their health and well-being. Being autonomous and without any restrictions within the home, many older adults do not set any rules around media use, resulting in long hours spent on these devices and long periods of inactivity. In contrast, a few older adults utilized technology to perform PA within the home. This shows that autonomy allows the individual freedom to carry out behaviours of their own choosing as highlighted in self-determination theory [93].

Many older adults suggested that restructuring or modifying the physical environment within the home assists them in performing PA within their home as well as enhances their autonomy, freedom, integrity, and independence within their home [94, 95]. Interestingly, many older adults suggested quite substantive modifications such as installing an indoor dance floor, swimming pool, sports and gym room, or purchasing PA equipment, such as a treadmill, to make their home environment conducive for PA. However, this significant modification would certainly require significant resources, time and finance. Therefore, the study findings supported and recommended the notion of ‘think small for large effects’ within the home space that helped older adults to map out small-scale activities to support their daily life-style activities like keeping PA devices in a convenient place, avoiding screens in bedrooms, or using the phone in only one room as compared to large-scale less realistic infrastructure changes. This also presents that SEM places a strong emphasis on the role of the physical environment and its interaction with diverse factors.

In contrast, many older adults were reluctant to make any changes to support increases in PA because they simply prefer to maintain the status quo, or, because their home environment was fashioned by their parents and loved ones and they were emotionally attached to it. Previous literature has also highlighted that the ageing process and ingrained memories increase an older adult’s sense of attachment, and the desire to remain in and age in one’s current home [96, 97]. Moreover, as suggested in past studies, family members within the home play an influential role in changing the environment [98]. This was poignantly made clear in our study as restrictions imposed by family members presented a major hindrance to modify home surroundings for some participants. If the home is not well adapted, this limits older adults’ mobility inside their home, particularly as people get older, they feel more vulnerable and endangered, therefore they seek greater safety and harmony [99] which means they are more likely to confines of their own home. Hence, the interaction of individual and social factors along with the environment of the individual play an important role in enhancing PA and minimizing SB, as described in the SEM of health behaviour [100–102].

Our findings suggest that there is still much to do at a policy level to motivate older adults to adopt PA within their lifestyle. The views of the older adults suggest that there was an increase in SB and a decrease in PA due to the imposition of the lockdown restrictions, which has previously been reported [103, 104]. This decline in PA might be due to isolation related to the pandemic [104, 105], as many older adults in our study reported being lonely, spending more time in sedentary activities like social media use, and watching TV and less time participating in PA. The restrictions meant that the social components that motivate many older adults to take part in activity were no longer available and still confine their activity even after the restrictions have been lifted. This highlights the need for policies to minimize older adults’ SB and enhance their PA within their home environment. Hence, the COVID-19 regulations created a restrictive environment that limited opportunities for older individuals to be active, hindering autonomy, competence, and relatedness, highlighted as key determinants of motivation by self-determination theory [93]. In the current study, older adults experienced a lack of autonomy in their choice to be physically active, had few opportunities to develop or experience competence in being active, and were unable to experience relatedness when being active, that for many older adults is a primary motivator. However, a few participants had increased their usage of their home and garden space for activity as a result of the lack of opportunity to engage in activity elsewhere and their experiences might offer valuable insight to inform such future policy.

As our findings illustrate, the previously described facilitators and inhibitors of PA and SB within the home are multifaceted and cannot be comprehended or addressed if different layers of the model are examined separately. Using these findings to develop interventions to address older adults’ home-based PA and SB suggests that accounting for the interactions, reciprocal associations, and dynamic nature of relationships between the factors, is most likely to produce effective outcomes for changing behaviour. For instance, one such interaction involves an older adult’s motivation and attitudes towards PA and SB at the individual level with a number of interpersonal factors, such as support from family and friends. It is also important to take into account interactions within a level, for example, the interaction between the individual factors of motivation and self-perceived health. It is well established that deteriorating health can demotivate older adults to be active [106].

When interpreting the present study findings, study strengths and limitations should be considered. This study has contributed to the evidence base on older adults’ home-based PA and SB by comprehensively using all levels of the SEM to interpret the facilitators of, and barriers to, reducing SB and increasing PA. Moreover, both individual interviews and focus groups with multi-diverse older adults allowed for wide-ranging discussions and enable in-depth exploration of their PA and SB and attitudes in regard to their home environment. However, a number of limitations should be taken into account in the current research. First, the size of typical UK home is decreasing [107] and this may have influenced older adults’ perceptions of their home space and garden. Second, older adults were recruited from low, middle and high socioeconomic (SES) backgrounds in an effort to ensure equal representation. However, high SES older adults overrepresented in our sample, irrespective of this over-representation the current study finding may be generalisable to areas which have similar home physical environment features.

Conclusion

The dynamic association between the diverse factors at different layer of SEM and home environment highlighted both the facilitators and barriers for older adults PA and SB that can be taken into consideration for optimum engagement. This suggests that the home environment cannot be addressed in isolation as it is complex and is influenced across different levels of the SEM. Therefore, interaction between these layers has given us an integrated perception of the older adults PA and SB within their home space.

To better understand how to promote PA and minimize SB in older adults’ home environments, a dynamic systems approach must take into account by bringing changes in these interactive determinants to intervene effectively. This will motivate older adults to develop intentions that reflect positive perceptions of control over their home environment which is significant for promoting PA.

Supporting information

Acknowledgments

The authors would like to thank all the older adults who were interviewed as part of this study.