Advertisement

Health Literacy and Moderate to Vigorous Physical Activity During Aging, 2004–2013

      Introduction

      Health literacy (the ability to read and understand health information) may help to support sustained participation in moderate to vigorous physical activity (MVPA) during aging; this relationship has never been examined longitudinally. This study aimed to investigate the relationship between health literacy and participation in weekly MVPA over an 8-year period among older adults.

      Methods

      Data were from interviews with 4,345 adults aged 52–79 years in the English Longitudinal Study of Ageing from 2004/2005 to 2012/2013, analyzed in 2015. Health literacy was assessed in 2004/2005 as reading comprehension of a medicine label, defined as “low” (≤2/4 items correct); “medium” (3/4); and “high” (4/4). The outcome was maintaining weekly MVPA at all of five time points from 2004/2005 to 2012/2013. A population-weighted logistic regression model was adjusted for sociodemographic, physical health, and cognitive (memory and verbal fluency) covariates.

      Results

      Overall, 72% (3,128/4,345) of the sample had high health literacy; 18% (797/4,345) had medium health literacy; and 10% (420/4,345) had low health literacy. Of those with high health literacy, 59% (1,840/3,128) consistently reported weekly participation in MVPA, compared with 33% (138/420) of those with low health literacy (AOR=1.37, 95% CI=1.04, 1.80). Better memory was weakly positively associated with long-term MVPA (AOR=1.03, 95% CI=1.00, 1.05, per point increase out of 24), as was better verbal fluency (AOR=1.05, 95% CI=1.01, 1.09, per point increase out of 9).

      Conclusions

      High health literacy and good cognitive function are independently associated with participation in weekly MVPA over an 8-year period during aging.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nutbeam D.
        Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.
        Health Promot Int. 2000; 15: 259-268https://doi.org/10.1093/heapro/15.3.259
      1. Kickbusch I, Pelikan JM, Apfel F, Tsouros AD. Health literacy: the solid facts. www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf. Published 2013. Accessed October 2, 2015.

        • Berkman N.D.
        • Davis T.C.
        • McCormack L.
        Health literacy? What is it?.
        J Health Commun. 2010; 15: 9-19https://doi.org/10.1080/10810730.2010.499985
      2. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). https://nces.ed.gov/pubs2006/2006483.pdf. Published September 2006. Accessed October 2, 2015.

        • Berkman N.D.
        • Sheridan S.L.
        • Donahue K.E.
        • Halpern D.J.
        • Crotty K.
        Low health literacy and health outcomes: an updated systematic review.
        Ann Intern Med. 2011; 155: 97-107https://doi.org/10.7326/0003-4819-155-2-201107190-00005
        • Davis T.C.
        • Wolf M.S.
        • Bass III, P.F.
        • et al.
        Literacy and misunderstanding prescription drug labels.
        Ann Intern Med. 2006; 145: 887-894https://doi.org/10.7326/0003-4819-145-12-200612190-00144
        • Kobayashi L.C.
        • Wardle J.
        • von Wagner C.
        Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing.
        Prev Med. 2014; 61: 100-105https://doi.org/10.1016/j.ypmed.2013.11.012
        • Morris N.S.
        • Field T.S.
        • Wagner J.L.
        • et al.
        The association between health literacy and cancer-related attitudes, behaviors, and knowledge.
        J Health Commun. 2013; 18: 223-241https://doi.org/10.1080/10810730.2013.825667
      3. Office of Disease Prevention and Health Promotion. Health communication and health information technology. www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology/objectives. Published October 2015. Accessed October 2, 2015.

        • Federman A.D.
        • Sano M.
        • Wolf M.S.
        • Siu A.L.
        • Halm E.A.
        Health literacy and cognitive performance in older adults.
        J Am Geriatr Soc. 2009; 57: 1475-1480https://doi.org/10.1111/j.1532-5415.2009.02347.x
        • Kobayashi L.C.
        • Wardle J.
        • Wolf M.S.
        • von Wagner C.
        Cognitive function and health literacy decline in a cohort of aging English adults.
        J Gen Intern Med. 2015; 30: 958-964https://doi.org/10.1007/s11606-015-3206-9
        • Kobayashi L.C.
        • Smith S.G.
        • O’Conor R.
        • et al.
        The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA.
        BMJ Open. 2015; 5: e007222https://doi.org/10.1136/bmjopen-2014-007222
        • Thomas P.A.
        Trajectories of social engagement and limitations in late life.
        J Health Soc Behav. 2011; 52: 430-443https://doi.org/10.1177/0022146511411922
        • Baker D.W.
        • Wolf M.S.
        • Feinglass J.
        • Thompson J.A.
        Health literacy, cognitive abilities, and mortality among elderly persons.
        J Gen Intern Med. 2008; 23: 723-726https://doi.org/10.1007/s11606-008-0566-4
        • Sudore R.L.
        • Yaffe K.
        • Satterfield S.
        • et al.
        Limited literacy and mortality in the elderly: the health, aging, and body composition study.
        J Gen Intern Med. 2006; 21: 806-812https://doi.org/10.1111/j.1525-1497.2006.00539.x
        • Cavanaugh K.L.
        • Wingard R.L.
        • Hakim R.M.
        • et al.
        Low health literacy associates with increased mortality in ESRD.
        J Am Soc Nephrol. 2010; 21: 1979-1985https://doi.org/10.1681/ASN.2009111163
        • Bostock S.
        • Steptoe A.
        Association between low functional health literacy and mortality in older adults: longitudinal cohort study.
        BMJ. 2012; 344: e1602https://doi.org/10.1136/bmj.e1602
        • von Wagner C.
        • Steptoe A.
        • Wolf M.S.
        • Wardle J.
        Health literacy and health actions: a review and a framework from health psychology.
        Health Educ Behav. 2009; 36: 860-877https://doi.org/10.1177/1090198108322819
        • Samitz G.
        • Egger M.
        • Zwahlen M.
        Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies.
        Int J Epidemiol. 2011; 40: 1382-1400https://doi.org/10.1093/ije/dyr112
        • Kvaavik E.
        • Batty D.
        • Ursin G.
        • Huxley R.
        • Gale C.
        Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom Health and Lifestyle Survey.
        Arch Intern Med. 2011; 170: 711-719https://doi.org/10.1001/archinternmed.2010.76
        • Leitzmann M.F.
        • Park Y.
        • Blair A.
        • et al.
        Physical activity recommendations and decreased risk of mortality.
        Arch Intern Med. 2007; 167: 2453-2460https://doi.org/10.1001/archinte.167.22.2453
        • Hamer M.
        • de Oliveira C.
        • Demakakos P.
        Non-exercise physical activity and survival:English Longitudinal Study of Ageing.
        Am J Prev Med. 2014; 47: 452-460https://doi.org/10.1016/j.amepre.2014.05.044
        • Geboers B.
        • Winter A.F.
        • De, Luten K.A.
        • Jansen C.J.M.
        • Reijneveld S.A.
        The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators.
        J Health Commun. 2014; 19: 37-41https://doi.org/10.1080/10810730.2014.934933
        • McAuley E.
        Self-efficacy and the maintenance of exercise participation in older adults.
        J Behav Med. 1993; 16: 103-113https://doi.org/10.1007/BF00844757
        • Stiggelbout M.
        • Hopman-Rock M.
        • Crone M.
        • Lechner L.
        • van Mechelen W.
        Predicting older adults’ maintenance in exercise participation using an integrated social psychological model.
        Health Educ Res. 2006; 21: 1-14https://doi.org/10.1093/her/cyh037
        • Buckley J.
        • Cohen J.D.
        • Kramer A.F.
        • McAuley E.
        • Mullen S.P.
        Cognitive control in the self-regularion of physical activity and sedentary behavior.
        Front Hum Neurosci. 2014; 8: 1-15https://doi.org/10.3389/fnhum.2014.00747
        • McAuley E.
        • Mullen S.P.
        • Szabo A.N.
        • et al.
        Self-regulatory processes and exercise adherence in older adults: executive function and self-efficacy effects.
        Am J Prev Med. 2011; 41: 284-290https://doi.org/10.1016/j.amepre.2011.04.014
        • Wolf M.S.
        • Gazmararian J.A.
        • Baker D.W.
        Health literacy and health risk behaviors among older adults.
        Am J Prev Med. 2007; 32: 19-24https://doi.org/10.1016/j.amepre.2006.08.024
        • von Wagner C.
        • Knight K.
        • Steptoe A.
        • Wardle J.
        Functional health literacy and health-promoting behaviour in a national sample of British adults.
        J Epidemiol Community Health. 2007; 61: 1086-1090https://doi.org/10.1136/jech.2006.053967
        • Osborn C.Y.
        • Paasche-Orlow M.K.
        • Bailey S.C.
        • Wolf M.S.
        The mechanisms linking health literacy to behaviour and health status.
        Am J Health Behav. 2011; 35: 118-128https://doi.org/10.5993/AJHB.35.1.11
        • Bennett J.S.
        • Boyle P.A.
        • James B.D.
        • Bennett D.A.
        Correlates of health and financial literacy in older adults without dementia.
        BMC Geriatr. 2012; 12: 30https://doi.org/10.1186/1471-2318-12-30
        • Buckley J.
        • Cohen J.D.
        • Kramer A.F.
        • McAuley E.
        • Mullen S.P.
        Cognitive control in the self-regulation of physical activity and sedentary behavior.
        Front Hum Neurosci. 2014; 8: 1-15https://doi.org/10.3389/fnhum.2014.00747
        • Clouston S.A.P.
        • Brewster P.
        • Kuh D.
        • et al.
        The dynamic relationship between physical function and cognition in longitudinal aging cohorts.
        Epidemiol Rev. 2013; 35: 33-50https://doi.org/10.1093/epirev/mxs004
        • Steptoe A.
        • Breeze E.
        • Banks J.
        • Nazroo J.
        Cohort profile: The English Longitudinal Study of Ageing.
        Int J Epidemiol. 2013; 42: 1640-1648https://doi.org/10.1093/ije/dys168
        • Thorn W.
        International Adult Literacy and Basic Skills Surveys in the OECD Region.
        OECD Publishing, Paris2009
        • Banks J.
        • Breeze E.
        • Cheshire H.
        • et al.
        Cognitive function.
        in: Banks J. Breeze E. Lessof C. Nazroo J. Retirement, Health and Relationships of the Older Population in England: The 2004 English Longitudinal Study of Ageing (Wave 2). The Institute for Fiscal Studies, London2006: 217-242
        • Steptoe A.
        • Demakakos P.
        • de Oliveira C.
        The psychological well-being, health and functioning of older people in England.
        in: Banks J. Nazroo J. Steptoe A. The Dynamics of Ageing: Evidence From the English Longitudinal Study of Ageing 2002-10 (Wave 5). Institute for Fiscal Studies, London2012: 98-182
        • Hamer M.
        • Lavoie K.L.
        • Bacon S.L.
        Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing.
        Br J Sport Med. 2014; 48: 239-243https://doi.org/10.1136/bjsports-2013-092993
        • Smith L.
        • Gardner B.
        • Fisher A.
        • Hamer M.
        Patterns and correlates of physical activity behaviour over 10 years in older adults: prospective analyses from the English Longitudinal Study of Ageing.
        BMJ Open. 2015; 5: e007423https://doi.org/10.1136/bmjopen-2014-007423
        • Matthews K.
        • Demakakos P.
        • Nazroo J.
        • Shankar A.
        The evolution of lifestyles in older age in England.
        in: Banks J. Nazroo J. Steptoe A. Wave 6: The Dynamics of Ageing: Evidence From the English Longitudinal Study of Ageing 2002-2012. The Institute for Fiscal Studies, London2014: 51-93
      4. Rothman K. Greenland S. Modern Epidemiology. 3rd ed. Lippincott-Raven, Philadelphia2008
        • NatCen Social Research
        English Longitudinal Study of Ageing (ELSA): Wave 1 to Wave 6: User Guide to the Core Datasets.
        NatCen Social Research, London2014
        • Warburton D.E.
        • Nicol C.W.
        • Bredin S.S.D.
        Health benefits of physical activity: the evidence.
        CMAJ. 2006; 174: 801-809https://doi.org/10.1503/cmaj.051351
        • Kobayashi L.C.
        • Wardle J.
        • von Wagner C.
        Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults.
        J Epidemol Community Health. 2015; 69: 278-283https://doi.org/10.1136/jech-2014-204733
        • Wolf M.S.
        • Feinglass J.
        • Thompson J.
        • Baker D.W.
        In search of “low health literacy”: threshold vs. gradient effect of literacy on health status and mortality.
        Soc Sci Med. 2010; 70: 1335-1341https://doi.org/10.1016/j.socscimed.2009.12.013
        • Weuve J.
        • Kang J.H.
        • Manson J.E.
        • Breteler M.M.B.
        • Ware J.H.
        • Grodstein F.
        Physical activity, including walking, and cognitive function in older women.
        JAMA. 2006; 292: 1454-1461https://doi.org/10.1016/S0084-3970(08)70261-5
        • Hillman C.H.
        • Erickson K.I.
        • Kramer A.F.
        Be smart, exercise your heart: exercise effects on brain and cognition.
        Nat Rev Neurosci. 2008; 9: 58-65https://doi.org/10.1038/nrn2298
        • Geda Y.E.
        • Roberts R.O.
        • Knopman D.S.
        • et al.
        Physical exercise, aging, and mild cognitive impairment.
        Arch Neurol. 2010; 67: 80-86https://doi.org/10.1001/archneurol.2009.297
        • Colcombe S.
        • Kramer A.F.
        Fitness effects on the cognitive function of older adults: a meta-analytic study.
        Psychol Sci. 2003; 14: 125-130https://doi.org/10.1111/1467-9280.t01-1-01430
        • Van Stralen M.M.
        • De Vries H.
        • Mudde A.N.
        • Bolman C.
        • Lechner L.
        Determinants of initiation and maintenance of physical activity among older adults: a literature review.
        Health Psychol Rev. 2009; 3: 147-207https://doi.org/10.1080/17437190903229462
        • Bauman A.E.
        • Reis R.S.
        • Sallis J.F.
        • Wells J.C.
        • Loos R.J.F.
        • Martin B.W.
        Correlates of physical activity: why are some people physically active and others not?.
        Lancet. 2012; 380: 258-271https://doi.org/10.1016/S0140-6736(12)60735-1
        • Smith S.G.
        • O’Conor R.
        • Curtis L.M.
        • et al.
        Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study.
        J Epidemiol Community Health. 2015; 69: 474-480https://doi.org/10.1136/jech-2014-204915
        • Newell S.A.
        • Girgis A.
        • Sanson-Fisher R.W.
        • Savolainen N.J.
        The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.
        Am J Prev Med. 1999; 17: 211-229https://doi.org/10.1016/S0749-3797(99)00069-0
        • Prince S.A.
        • Adamo K.B.
        • Hamel M.E.
        • Hardt J.
        • Gorber S.C.
        • Tremblay M.
        A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review.
        Int J Behav Nutr Phys Act. 2008; 5: 56https://doi.org/10.1186/1479-5868-5-56
        • WHO
        Global Recommendations on Physical Activity for Health.
        WHO, Geneva2010
        • Parker R.
        • Baker D.
        • Williams M.
        • Nurss J.
        The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills.
        J Gen Intern Med. 1995; 10: 537-541https://doi.org/10.1007/BF02640361
        • Davis T.
        • Crouch M.
        • Long S.
        • et al.
        Rapid assessment of literacy levels of adult primary care patients.
        Fam Med. 1991; 23: 433-435