Negotiating a physically active life in tune with ageing: a grounded theory study of older persons’ experiences of participating in high-intensity interval training | BMC Geriatrics

We have constructed a GT that revolves around the core category Negotiating a physically active life in tune with ageing. This refers to participants’ experiences of engaging in HIT interwoven with reflections on the uncertainties of ageing and strategies for maintaining a physically active lifestyle. The core category captures an ongoing process of negotiating healthy and active ageing intertwined with key processes of being empowered and gaining more grit when participating in the HIT exercise group (Fig. 3).

A GT model of older persons’ experiences of participating in HIT

Our GT was informed by the conceptual framework, i.e., stereotype embodiment, ageist practices and self-efficacy. The conceptual framework permeates all four categories and the core category, acting as a plausible explanation of how participation in HIT groups challenges negative age stereotypes and ageist practices, and boosts self-efficacy for high-intensity exercise.

Moreover, age is a central part of the core process as an ever-present factor and represents the uncertainty of ageing that participants described in relation to, for example, physical activity and exercise behaviours. Age-related limitations were described as a reality that needs to be considered and accommodated for, or as an imaginary threat lurking in the outskirts of participants’ minds, described as something that may come to affect them in the near or far future.

Our GT captures participants’ individual experiences and collective negotiations, which are also related to norms and values in the larger society. Participants’ views of themselves, including their age and their previous experiences of exercising, shaped how they regarded physical activity, exercise, and the HIT programme itself. Thus, their lived experiences, from the past to the present, along with thoughts about the future, unfolded a variety of processes that reciprocally shaped and affected them when they participated in the HIT groups.

The core category was created from four distinct yet interconnected categories: Grit in the moment and overall life, Empowered by the training group, Navigating one’s physically active self, and Committing to exercise for duty and pleasure. Each category represents a variety of actions and processes derived from our empirical data. The data analysis process is outlined in Additional file 1. The categories are described in detail below, along with examples of interspersed references to the conceptual framework to elucidate the interconnections between empirical data and the conceptual framework. The interconnections are further elaborated in the discussion section.

Direct quotes in the text are denoted M for male and F for female participants along with each focus group number.

Grit in the moment and overall life

This category was created based on participants’ experiences of successively gaining ‘grit’ in relation to training in the specific HIT programme, but also on how this feeling of grit carried over into their everyday life. Our interpretation of grit is, for instance, expressed in terms of perceived ‘capability, stamina, and motivation’, which also corroborates the concept of self-efficacy. Depending on previous and present experiences of physical activity and exercise, participants approached the HIT in various ways.

Vitalised by challenging oneself

The HIT programme was considered a way to break an inactive lifestyle while also being fun and easy to commit to. It served as a reminder that older persons can push hard through intervals. For others, the HIT programme brought a welcome surprise and insight into their capability to do interval training, as a ‘fun’ way of exercising. This newfound experience of challenge and feeling vitalised led them to reconstruct and negotiate how they viewed themselves as exercising individuals with capabilities far beyond what they had thought possible. These positive experiences can be interpreted to challenge negative age stereotypes and ageist practices and to lead to a boosting of efficacy beliefs through mastering of HIT.

While many participants had been accustomed to exercising in the past, narratives of a decline in strenuous exercise as one became older were told, and these participants declared that they had truly enjoyed ‘pushing hard’ on the bikes during the intervals.

-Well yes, it was fun to [exercise]…that’s what you did in your youth, you did some sports. And then [in your youth] it was like you almost spit blood in the end. But I found that this was great, to sort of exert yourself a little and feel that you really had to push yourself. Yes, really great. (M)

-Yeah, and not just plod on, in a kind of normal walking pace. (M, FG1)

The intense intervals were further discussed by two participants:

-I’ve almost been looking forward to these six seconds. (M)

-When you get to push yourself. (F)

-Yes, that’s right, that you get to push yourself, yeah. And then… go down to zero and then…you charge up again. Damn it, you think, now I’m going to get through this. So that…I think that was really good. (M, FG1)

Feelings of happiness, satisfaction, and being invigorated both during and after HIT were described. Some even would have liked to have longer and harder training sessions, especially in the beginning of the training period, as they, despite the intervals, ‘didn’t get sweaty or tired’ and didn’t get any muscle soreness in between sessions. A different perspective was given by participants with less experience of hard exercise. They described how the setup helped them understand how they should feel during the intervals, and how they enjoyed challenging and pushing themselves more than they were used to.

-Yeah, for me it was perfect because I had entered a bit of a lazy stage in life. When the sofa felt nice and comfortable, but always with a guilty conscious about not doing anything. This form of short and intense [exercise] using such a small part of the day as possible suits me perfectly. I think it’s great. (F, FG4)

Harvesting the benefits of exercising

Perceptions of the benefits of exercising with HIT varied across a wide spectrum from no distinct perceived effects to experiences of finding it easier to cycle and walk uphill, getting stronger leg muscles, and experiencing easier breathing during exercise or lesser feelings of exertion despite higher resistance during HIT. Having positive experiences from exerting oneself and increasing one’s pulse during the training was described as carrying over to other activities and situations in which the participants pushed themselves harder than usual and tried to mimic an interval by, for example, walking or biking faster uphill. These narratives elucidate a generalisation of increased efficacy beliefs for exercising through positive interpretations of physiological states, e.g. increased pulse, as something desirable and positive to strive for.

Other perceived benefits from HIT included improved feelings of well-being and sleep, as well as needing fewer hours of sleep but still feeling more rested. There were also experiences of being more positive and alert, with more drive and motivation to do things in general.

-Well, you have a little more energy and become more motivated to do different things because you feel like you have the energy and stamina to do it. It can be like small things around the house, you know, but now I’m doing it. I’m not just sitting there in front of the telly anymore. I started painting the house a few days ago, maybe I hadn’t… I probably would have thought it through a bit more before, how to do it, but now I just got started, boom, full steam ahead. (M, FG1)

While some individuals were resolute in their beliefs about the valuable effects of HIT, others expressed hesitance regarding any perceived benefits. The sceptics did not believe that HIT could yield any significant results, as they did not get tired or perspire much during the sessions. A prevailing belief was that effective exercise must result in participants feeling ‘tired and sweaty’. Consequently, the training was perceived as too undemanding to yield any substantial effect. However, those harbouring doubts conveyed that if the HIT programme demonstrated favourable outcomes, they would recommend it to everyone they knew, as it was perceived as such an easy way to exercise.

Empowered by the training group

This category is based on participants’ experiences of being empowered by exercising in a group setting. Together with their peers, they developed a sense of capability and motivation to persist with exercise as well as drive to explore alternative exercise modalities and training facilities while preparing for ongoing exercise beyond the completion of the training project. These results point at increased self-efficacy for HIT and a generalisation of increased self-efficacy for other kinds of exercise behaviours, as well as a challenging of negative age stereotypes and ageist practises.

Acknowledging the merits of exercising in a group

An abundance of valuable benefits connected to exercising in a group were experienced. Having set times and days for exercising with the same individuals gave a structure to their week that facilitated devotion to exercise, as well as a positive feeling of needing to attend each session as the others in the group would otherwise notice that they were absent. They perceived that the group helped them continue with their training and did not think they would have done that had they exercised on their own.

-I think it becomes automatic if you are a group, you have to go there. If you’re on your own, ‘I couldn’t be bothered today—I’ll do it tomorrow’. But when you’re in a group, you have a set time and you’re part of that group. Then you must go. (F)

-I think that’s important too, having a time and that you have planned for it. If you’re doing it on your own, then it’s a little bit, the lazy side takes over. (M, FG4)

During each session, the group and the coaches helped them to exert themselves more than if they had been exercising on their own. The chance of reaching their set goals for each session was greatly improved by seeing the other group members pushing themselves. Moreover, they started to create bonds and social connections with each other in the group, which was likened to ‘therapy’. One group described how they started to meet up for a bit of a chat before each training session, and another group decided to have coffee once a week after their session. Thus, participating in the training not only involved being active and exercising but was also found to develop an important social connectedness between participants.

-I think it’s positive. I can come and have a fairly low level of… mentally … and find things quite challenging, both this and that. But… the group has given me more energy. And afterwards I’ve felt that my mood has improved. At least a bit, sometimes even more. So for me it’s important to have this positive group. (F)

–We’ve usually met up a bit before, and then we’ve been sitting there chatting about everything and nothing. Life and death and, everything. (F, FG4)

Another special connectedness involved the coaches who ran the exercise sessions. Coaches were seen as a very important part in the overall HIT experience and participants felt ‘taken care of’ and ‘seen’ by the coaches, which was described as a thoroughly positive and welcoming experience.

Preparing for continued exercise without the group

This category entails discussions about different actions that participants took to continue exercising regularly on their own, without the HIT group. Individuals who had been used to exercising on a regular basis previously seemed to be more inclined to find ways to continue and plan for ways to exercise when the project was coming to an end. The positive effects they had experienced of the HIT were expressed as a drive to continue exercising. Their drive led to varied actions, such as looking for gyms that offered similar bike training in groups, buying new or dusting off their own exercise bikes, which they intended to use at home, rallying fellow residents in an apartment building to persuade the owner to invest in gym equipment, and exploring alternative exercise options in nearby gyms. Some participants intended to commit to outdoor activities like walking and cycling. An intention to continue with interval training was discussed, but finding the appropriate resistance levels aligned with the HIT programme was perceived as somewhat challenging to do on one’s own. Ultimately, some declared that they were going to rely on their ‘gut feeling’, pushing hard during intervals, resting, and then repeating the process. While a range of innovative ways to maintain exercise routines were talked about, there were also participants who exhibited hesitancy and uncertainty about exercising independently.

-But then, I would really like to continue, I have to, I want to continue with this, but how? What if I miss this [high-intensity interval training] as well, will I fail and drop this? (F, FG3)

Concerns about missing the group setup and doubts regarding their ability to perform intervals independently were expressed. Thus, while some were hesitant about their ability to continue to exercise on their own, others questioned their capacity to sustain high-intensity intervals or opted directly for a return to their prior light activities without intervals. Such narratives corroborate self-efficacy theory, illustrating how self-efficacy for HIT among these participants is directly related to performing the specific behaviour, the high-intensity intervals, in the HIT group and has not generalised to other settings.

Navigating one’s physically active self

This category refers to participants’ navigating of their physically active self by engaging in HIT and provides a broader context to their experiences of staying active. Discussions in FGs flowed naturally and contained jokes and laughter about the merits of ageing mixed with serious narratives about illness and death and the hardships associated with advancing age. Participants described ‘healthy ageing’ in relation to staying active, as an ongoing process affected by factors such as their physical health and perceived ability to exercise, relatives and friends, the larger society, and the crucial transformation that happened when they entered retirement.

Relating to one’s own active ageing in social contexts

The nature of ageing in relation to being active was described as a challenging and an ongoing uncertain process in which participants thought that being old and healthy should not be taken for granted. Accepting one’s ageing was an ambiguous process in which feelings of being grateful for fairly good health and doing the best with what you have were juxtaposed with descriptions of feeling sad about not being able to continue with activities that one had previously enjoyed. This ambiguity was further elaborated in relation to participants’ chronological age, where some said that they had a hard time identifying as an older person, indicating a rejection of negative age stereotypes to their self-image.

Thus, ageing was often described in relation to other individuals and the society. Seeing and experiencing other people getting older shaped the participants’ own identities and perceptions of ageing.

-Well, we are actually older, and it’s… (M)

-And we should be happy that we’ve come this far. (F)

-And there’s arthritis, and there’s heart problems and blood pressure, and things like that… and then there’s those who get cancer also, but it’s always these problems that you read about and hear when talking to people. (M)

-I know people my age who have already been affected by dementia. So of course… you never know what will happen to you. (M, FG1)

Reaching old age was not described as a strong wish or priority. Instead, they acknowledged a hope and preference to have health and well-being while they were living.

Challenges related to accepting one’s ageing and belonging to the older generation came with a sense of ambivalence and tension, where participants portrayed themselves through an ‘us and them’ narrative. Thus, they described themselves as disparate to older and younger generations alike. This ambivalence appeared, for example, in portrayals of themselves as being far more physically active nowadays and ‘not as old’ as previous generations of older persons. These narratives suggest that some participants had endorsed negative views, age stereotypes, about earlier generations of older persons but rejected these stereotypes when considering their own self-image.

In contrast, younger generations were depicted to differ in other ways. Participants viewed themselves as more mature than younger generations, without a need to compete or compare their appearance or physique with others. To avoid ‘feeling like outcasts’, some described how they had previously exercised during daytime hours, deliberately avoiding gym sessions with younger individuals.

-Some [younger] people really feel the need to show off, and they can barely use any equipment until they make sure someone is noticing how skilled they are. It’s so foreign to me that I feel like saying ‘get a life’. Is that what life is about? So, you just have to ignore them, do your workout, and then leave. But of course, they also look at us, naturally, so you just have to close your eyes and keep your thoughts to yourself. (M)

-Go during the day. (F)

-Yes, you should go during the day because they [the younger generations] are often there in the morning and evening. (F)

-In the evenings, all dressed up and made up, it’s so fancy. You start wondering if you yourself came from the countryside. (F)

-No, you should go during the day; then you can be whoever you want. (F, FG4)

Thus, having difficulties in identifying with other generations led to a desire to exercise with people they felt more closely connected to—their age group.

Trying to stay active in the transformation to pensioner

Becoming a pensioner was discussed in depth and was closely related to discussions about ageing, activity and exercise. It was depicted as a major life event in relation to ageing and forced participants to transition into finding and constructing a new identity. This transition into retirement can be related to age stereotypes and functioned as an arbitrary passage into the identification as ‘old’ for some of the participants. Transitioning to life as a pensioner meant that they had to adjust to a new lifestyle outside their work environment, and try to find new priorities and meaning in their lives. Finding this new identity was described as a life-changing process invoking ambivalent perceptions of the advantages and disadvantages of staying in the workforce. Becoming a pensioner was portrayed as entailing challenges related to staying active and exercising. Whilst in the workforce, staying active was facilitated by several processes, such as biking or walking to work each day. Moreover, participants described how they used to exercise with colleagues on a regular basis and that exercising was encouraged by their employer through subsidised gym cards and time off for training during working hours. When these supporting actions disappeared as they left the workforce and became pensioners, the participants experienced difficulties finding their own routines and drive to stay active, as expressed in rich descriptions:

-Now you have to do everything yourself. Even if you have all the time in the world, you still have to manage all the projects yourself. I think that’s a real difference. When you worked, you got so much for free in a way. Even though you were working, it felt like you still did more. (F)

-That’s exactly how it is, and the more you do, the more motivation you get to do more, because when you become inactive, it’s like… (M)

-Then nothing happens. …then it becomes a vicious circle. (F)

-That’s how it is. (F, FG3)

A sense of becoming insignificant and left alone upon becoming a pensioner was discussed.

Moreover, apart from needing one’s own drive to exercise and stay active, the participants also acknowledged how people around them somehow treated them differently due to their increasing age and physical capability.

-My sons kind of complain… they say I’m old, ‘No, you shouldn’t stand at the top of the ladder and paint, no, you shouldn’t do this and that’. (M)

-It’s just concern (M).

-But common, I’ve done that before. ‘Yes, but now you have to consider that you’re older, your balance is worse’, and yada yada. Have I suddenly been declared incompetent just because I’m a pensioner? (M, FG2)

Perceptions of being treated differently were also recounted in relation to the HIT programme, where participants thought that the resistance was too low in the beginning of the exercise period. They were unaware of the HIT setup, which involved beginning their training period at a lower resistance level than they were capable of tolerating. This deliberate approach was part of the protocol designed to help participants become comfortable and familiar with the high-intensity intervals. However, this was mistakenly interpreted as a product of their age, with the assumption that the coaches were overly concerned about their health before allowing them to increase the resistance on their bikes. Interpretations such as these suggest that participants identified as members of the older population while questioning potential ageist practices and negative age stereotypes manifested by relatives and the coaches.

Committing to exercise for duty and pleasure

The process and drive to exercise were discussed from several perspectives, resulting in a category with various connotations shaped from participants’ experience of exercise, their current individual life situation and health status, as well as external drivers from family and friends, or society. These discussions can be directly related to stereotype embodiment, ageist practices and self-efficacy theory. Theoretical underpinnings in our conceptual framework stipulate that the images that we construct of others, and ultimately of ourselves, based on age operate in two directions—longitudinally throughout our lives and top-down from the surrounding society to the individual. Participants acknowledged that various factors could act either as supportive or as barriers to committing to exercising. Moreover, while some committed to exercise out of sheer pleasure and joy, others perceived it as a duty they had to uphold to maintain their health.

Finding own drive to exercise

One reason to commit to exercise was the desire for health and well-being and being able to live an active lifestyle for as long as possible. Maintaining health by exercising was also perceived as a way of fulfilling one’s civic duty as a responsible citizen. This drive to exercise was linked to the desire to delay the need for support from relatives and society, and to avoid becoming a burden on others. Thus, a strong wish to stay autonomous in increasing age was important and contributed to participants committing to exercise.

-Well, I guess that the motive is to have the best possible old age and avoid being taken care of when you’re 80. (M)

-That one should be able to feel good for as long as possible. (F, FG1)

Other drivers for committing to exercise were to have a purpose, something to do to fill the days with, or a way of breaking a sedentary lifestyle due to previous ill health or, as some described, ‘laziness’. Another major reason to commit to exercise was that the action of exercising was regarded as fun and pleasurable in its own right and led to feelings of increased well-being.

Finding one’s own drive to exercise also entails claims about participants’ self-images, not only based on their age, in relation to their experience of exercise, i.e., how they viewed themselves as exercising persons. Their self-image seemed to be based on experiences in the past as well as the present, which is in line with teachings on self-efficacy stipulating that former experiences of mastering, e.g., physical exercise behaviours will strengthen a person’s efficacy beliefs and chances of executing this behaviour in the future.

Acknowledging social support and availability to exercise

This subcategory was shaped from descriptions outlining support from family and friends and the larger society, e.g., the municipal and local training facilities as well as the nature and environments in the participants’ surroundings, which were acknowledged as helpful or hindering for exercise behaviours.

Relatives were sometimes both a major influence and driver for participants to commit to exercise. Many had spouses that cheered them on to exercise and they were also seen as great companions during physical activities such as going for walks in the forest or riding a bicycle. Getting verbal support from others and seeing other older people exercising, such as spouses and friends, can be seen to strengthen self-efficacy beliefs through modelling and verbal persuasion behaviours from important others. Descriptions were made of receiving gym passes for Christmas, and how their children were supportive of their wish to exercise.

-I have received applause from children and the whole family, all relatives, ‘Mary has finally started to move’. (F, FG4)

Knowledge of the importance and merits of exercising were often discussed between participants in the FGs, creating a sense of being responsible for and having a responsibility for one’s own health. Recollected news reports and government campaigns were brought up in discussions. However, having this knowledge did not necessarily carry over to regular exercise behaviours. Instead, their commitment to exercising was deeply affected by their opportunity to stay active. High costs associated with joining a training facility, long distances or difficulties in finding transportation to a training facility, troubles finding suitable exercise classes, and set gym times for older persons with subsidised memberships were described as barriers to exercising.

-Yes, I think that they could be more generous towards us over 65 and that it [set gym times] shouldn’t only apply from 7 [am] to 1 [pm]. Take myself as an example. I’ve only been able to do yoga and that class is only given at, well, eight o’clock in the evening at XX [a local training facility]. (F, FG3)

To beat the financial barrier for older persons to exercise, participants suggested that training facilities should be free for all people in the older population. This was narrated from a win–win perspective where older people would reap individual health gains from being more active and the government and health-care sector would save resources in the long run due to a healthier older population.

Physical activities and exercise were also discussed in relation to seasonal changes. Depending on the season, participants described how they, for example, cross-country ski and shovel snow in the winter, and cycle, work in the garden, and go for walks in the summer. Moreover, seasonal changes also affected their ability to get to training facilities.

-Well, I’ve lived close to the gym, so it’s been ok. Because it can’t be too far away, if you have to start the car and its icy and no, then it’s easy to back away. It [the training facility] has to be easy to get to. (F)

-I think so too. Close, and easy to get to. (F, FG4)