[Factors relating to stages of change in walking exercise behavior among older adults living in a hilly, mountainous area].

Objectives: We sought to identify factors relating to stages of change in walking exercise behavior among older adults living in a hilly, mountainous area in search of effective interventions to aid transitions.

Methods: An anonymous self-administered questionnaire survey was conducted with all older adults aged between 60 and 74 years (n=752) living in Takahashi City in the district of Kawakami, Okayama Prefecture. Questionnaires were distributed by local volunteer staff to 752 older adults, who completed and mailed the questionnaires to the principal investigator. Data on participants' demographic characteristics (gender, age, family structure, etc.), stages of change in walking exercise behavior, self-efficacy, perceived physical environment, and perceived social environment were collected through the survey. The participants were divided into non-walking, preparation, and walking subgroups. The χ(2), Kruskal-Wallis, Mann-Whitney U, and Bonferroni's multiple comparison tests were performed. Significance was set at 0.05.

Results: of 325 returned questionnaires (response rate, 43.2%), 164 completed questionnaires were analyzed. Females were significantly more likely to be physically active than were males. The preparation group had the largest number of participants (n=69, 42.1%), while the walking group had the smallest (n=43, 26.2%). The Kruskal-Wallis test revealed differences between stages of change in walking exercise behavior in terms of self-efficacy, perceived physical environment (landscape), and perceived social environment (all items). Multiple comparisons revealed that there were significant differences between the non-walking and preparation groups in self-efficacy, landscape, and advice/guidelines, while there were significant differences between the preparation and walking groups in self-efficacy and understanding/empathy.

Conclusion: Moving through the stages of change in walking exercise behavior was associated with gender, self-efficacy, the physical environment (landscape), and all components of the social environment. These findings suggest that in order to help older adults transition successfully through these stages of change, it is necessary to implement individualized interventions with due regard to landscape preservation, social environment, and self-efficacy, as well as participants' current stage of change.