title: Which older people decline participation in a primary care trial of physical activity and why: insights from a mixed methods approach.
abstract: BACKGROUND
  Physical activity is of vital importance to older peoples' health. Physical activity intervention studies with older people often have low recruitment, yet little is known about non-participants.
  
  
  METHODS
  Patients aged 60-74 years from three UK general practices were invited to participate in a nurse-supported pedometer-based walking intervention. Demographic characteristics of 298 participants and 690 non-participants were compared. Health status and physical activity of 298 participants and 183 non-participants who completed a survey were compared using age, sex adjusted odds ratios (OR) (95% confidence intervals). 15 non-participants were interviewed to explore perceived barriers to participation.
  
  
  RESULTS
  Recruitment was 30% (298/988). Participants were more likely than non-participants to be female (54% v 47%; p = 0.04) and to live in affluent postcodes (73% v 62% in top quintile; p < 0.001). Participants were more likely than non-participants who completed the survey to have an occupational pension OR 2.06 (1.35-3.13), a limiting longstanding illness OR 1.72 (1.05-2.79) and less likely to report being active OR 0.55 (0.33-0.93) or walking fast OR 0.56 (0.37-0.84). Interviewees supported general practice-based physical activity studies, particularly walking, but barriers to participation included: already sufficiently active, reluctance to walk alone or at night, physical symptoms, depression, time constraints, trial equipment and duration.
  
  
  CONCLUSIONS
  Gender and deprivation differences suggest some selection bias. However, trial participants reported more health problems and lower activity than non-participants who completed the survey, suggesting appropriate trial selection in a general practice population. Non-participant interviewees indicated that shorter interventions, addressing physical symptoms and promoting confidence in pursuing physical activity, might increase trial recruitment and uptake of practice-based physical activity endeavours.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Rogers
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
authors.affiliation: Gerontology and Health Services Research Unit, Brunel University, London UB8 3PH, UK. christina.victor@brunel.ac.uk.
authors.forename: Christina
authors.initials: C
authors.lastname: Victor
authors.forename: Alison
authors.initials: A
authors.lastname: Woodcock
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Limb
authors.forename: Sally
authors.initials: S
authors.lastname: Kerry
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.forename: Carole
authors.initials: C
authors.lastname: Beighton
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.forename: Fredrika
authors.initials: F
authors.lastname: Adams
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010358:Patient Participation / Q000379:methods* / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods*; D016138:Walking / Q000502:physiology* / Q000523:psychology*
references.citation: BMJ Open. 2012 Dec 14;2(6):
references.pmid: 23242479
references.citation: BMC Health Serv Res. 2008 Aug 08;8:169
references.pmid: 18691392
references.citation: J Geriatr Phys Ther. 2011 Jul-Sep;34(3):138-47
references.pmid: 21937904
references.citation: Age Ageing. 2004 May;33(3):287-92
references.pmid: 15082435
references.citation: Epidemiology. 1994 Jul;5(4):456-61
references.pmid: 7918817
references.citation: Age Ageing. 2011 Nov;40(6):659-65
references.pmid: 21911335
references.citation: Lancet. 2012 Jul 21;380(9838):247-57
references.pmid: 22818937
references.citation: Am J Prev Med. 2002 Aug;23(2 Suppl):80-6
references.pmid: 12133741
references.citation: Br J Sports Med. 1998 Sep;32(3):236-41
references.pmid: 9773174
references.citation: Trials. 2010 Jan 18;11:6
references.pmid: 20082696
references.citation: Aging Clin Exp Res. 2005 Jun;17(3):236-45
references.pmid: 16110738
references.citation: Control Clin Trials. 2000 Oct;21(5 Suppl):212S-7S
references.pmid: 11018578
references.citation: BMC Public Health. 2013 Jan 04;13:5
references.pmid: 23289648
references.citation: Br J Gen Pract. 2004 Mar;54(500):189-95
references.pmid: 15006124
references.citation: Am J Epidemiol. 1991 Jul 15;134(2):220-31
references.pmid: 1862805
references.citation: Am J Prev Med. 2003 Oct;25(3 Suppl 2):172-83
references.pmid: 14552942
references.citation: Health Policy. 1996 Jul;37(1):53-72
references.pmid: 10158943
references.citation: BMC Public Health. 2008 May 27;8:182
references.pmid: 18505574
references.citation: J Gerontol B Psychol Sci Soc Sci. 1997 Sep;52(5):S252-8
references.pmid: 9310097
references.citation: Arch Intern Med. 2001 Oct 22;161(19):2309-16
references.pmid: 11606146
references.citation: Prev Med. 2005 Aug;41(2):622-8
references.pmid: 15917061
references.citation: BMJ. 2008 Dec 11;337:a2509
references.pmid: 19074218