title: An exploration of barriers and facilitators to older adults' participation in higher impact physical activity and bone health: a qualitative study.
abstract: CONCLUSIONS
  This qualitative study explored the acceptability of high-impact physical activity for increasing bone strength in later life. Thematic analysis established the barriers and facilitators to this physical activity. They prioritised joint over skeletal health, of which they had little concept. Interventions need to clearly communicate the rationale and benefits.
  
  
  BACKGROUND
  The aim of this study was to explore the acceptability of doing high-impact physical activity in later life.
  
  
  METHODS
  This qualitative study was embedded within a large-scale observational study and was designed to address specific objectives and feed into a subsequent intervention. Five focus groups with physically active men and women (over 50 years) were used to develop an interview topic guide to explore the acceptability of high-impact physical activity in older men and women (over 65 years) in South West England. A total of 28 semi-structured interviews with 31 participants were then conducted and transcripts analysed thematically.
  
  
  RESULTS
  Three main barriers emerged: conceptualising bone, damage to joints and falling/safety concerns. Two main facilitators were also identified: the need to understand clear tangible benefits and incorporation of activity into everyday habits. Older adults were interested how high-impact physical activity would help to maintain their mobility, independence or social relationships. Some participants wanted tangible feedback from accelerometers, health care professionals and/or bone scans in order to develop a more intimate knowledge of their bone health.
  
  
  CONCLUSIONS
  Interventions incorporating high-impact physical activity for older adults need to communicate how this activity can impact more broadly on health and lives; that physical activity will be safe, beneficial and not damaging to their joints will need to be clearly conveyed. Ways in which high-impact physical activity can be habitualised into everyday activities, be fun and interactive may help facilitate longer term adoption.
authors.affiliation: Musculoskeletal Research Unit, Learning and Research Building, The University of Bristol, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. bethany.simmonds@bristol.ac.uk.
authors.forename: B A J
authors.initials: BAJ
authors.lastname: Simmonds
authors.affiliation: Musculoskeletal Research Unit, Learning and Research Building, The University of Bristol, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Hannam
authors.affiliation: Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, The University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Fox
authors.affiliation: Musculoskeletal Research Unit, Learning and Research Building, The University of Bristol, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Tobias
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015519:Bone Density / Q000502:physiology*; D004739:England; D015444:Exercise / Q000502:physiology / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D015577:Geriatric Assessment; D015438:Health Behavior / Q000502:physiology; D006293:Health Promotion; D006801:Humans; D007596:Joints / Q000293:injuries; D008297:Male; D009042:Motivation; D036301:Qualitative Research; D016138:Walking / Q000502:physiology
keywords: Bone health; High impact; Older adults; Physical activity; Qualitative