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Copyright ? 2006-2013 Scientific Research Publishing Inc. All rights reserved.
Advances in Applied Sociology
2013. Vol.3, No.2, 151-156
Published Online June 2013 in SciRes (http://www.scirp.org/journal/aasoci) http://dx.doi.org/10.4236/aasoci.2013.32020
Copyright © 2013 SciRes. 151
Perceived Health, Physical Activity and Sport among
the Elderly of Spain
Rafael Serrano-del-Rosal1, Lourdes Biedma-Velázquez1, David Moscoso-Sánchez2,
1Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
2Social Sciences Department, Pablo de Olavide University, Sevilla, Spain
3Faculty of Physical Activity and Sport Sciences, Polytechnic University of Madrid, Madrid, Spain
Received April 1st, 2013; revised May 2nd, 2013; accepted May 10th, 2013
Copyright © 2013 Rafael Serrano-del-Rosal et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Purpose: It determines if participating in sports and/or physical activity influences perceived health
among the elderly. Basic procedures: Data were drawn from a population subsample of subjects aged 65
- 79 years old that took part in a survey conducted in 2008 by the IESA-CSIC. A regression model was
performed with perceived health status with the dependent variable and sociodemographic characteristics
and physical activity as independent variables. Results: Physical activity is closely associated to per-
ceived health, although sport has little influence on this relationship. Conclusions: Doing exercise or
feeling that one is physically active makes the elderly feel better about their health status. However, this
age group practises few sports and sport is not found to have an important or constant influence on
self-perceived health status among the elderly.
Keywords: Perceived Health; Physical Activity; Sport; Elderly
Much attention has been given in the specialised literature on
physical activity, sport and health to the association between
physical activity and health. While many authors have demon-
strated this relationship from a physiological approach, others
have focused on psychological, attitudinal or behavioural fac-
tors among others (Barrios, Borges, & Cardoso, 2003).
All of these approaches coincide in acknowledging the bene-
ficial effects of sport and physical activity on health at any age
(USDH, 2008; Armstrong & Morgan, 1998), with some studies
focusing specifically on the benefits of exercise tailored to the
elderly (Weineck, 2001).
As regards the issue of health and physical activity, it is im-
portant to bear in mind that the most highly developed western
societies are characterised by two fundamental trends. On the
one hand, processes that were once carried out by human be-
ings by means of sheer physical strength and activity (transport,
work, etc.) have now been mechanised and automated, thus
giving rise to an important and relatively recent social phe-
nomenon: sedentary life. On the other hand, life expectancy has
increased to record levels (Fernández, Clúa, Báez, Ramírez, &
Prieto, 2000). These trends have led to population ageing; a
process that is particularly marked in societies such as Spain
where citizens aged 65 years or older account for 16.5 per cent
of the population according to data from the Spanish Institute of
Statistics (INE, 2008); a percentage that increases to nearly 19
per cent in the case of women, thus ranking Spain among the
countries with the oldest population in the world. Contempo-
rary western societies therefore face a two-fold challenge: an
ageing population and sendentariness. Both of these factors
affect people’s health and are a matter of concern to public
authorities responsible for analysing the social and economic
costs of these social phenomena (Weineck, 2001). Sedentary
lifestyle is believed to be the cause of 9 - 16 per cent of all
deaths occurring in developed western countries (Entrala, Igle-
sias, Veigas, & De-Jesús, 2003) and held to be the underlying
cause of death, disease and disability by the World Health Or-
ganization (WHO). According to WHO, sedentary lifestyle is
among the ten leading risk factors of death and disability in the
world as it is associated to cardiovascular disease, diabetes,
high blood pressure, obesity, osteoporosis and depression,
among other disorders (WHO, 1952). In recent decades, how-
ever, the concept of health has extended beyond a strictly bio-
medical definition of the term (absence of disease or infirmity).
WHO, for example, defines health as a state of complete
physical, mental and social well-being (WHO, 1952). Conse-
quently, research into the effects of sedentary lifestyles on
health and population ageing should not be measured strictly in
terms of objective or biomedical indicators of health. In this
line, perceived health status has been shown to be an excellent
proxy of overall health as it reflects the multidimensionality of
the concept of health as a state of overall well-being
(Fernández-Ballesteros, 1992; Ware, 1987; Testa & Simonson,
1996). Perceived health status has also been shown to be an
excellent predictor of mortality and an even more comprehend-
sive and effective indicator than clinical analysis (Idler &
Beyamini, 1997). It has also been found to have an influence on
the use of healthcare services and the monitoring of patient
R. SERRANO-DEL-ROSAL ET AL.
response to physicians’ advice (Aday & Andersen, 1981).
According to the WHO definition, physical activity is asso-
ciated to health and health-impacting lifestyles such as alcohol
consumption, tobacco use, diet and nutrition and others. Regu-
lar physical activity has been shown to have clear benefits for
health (USDH, 2008; Corbin, Pangrazi, & Welk, 1994). Some
authors and institutions hold that both adults and the elderly can
gain additional health benefits through physical activity
(ACSM, 2009) when the activity is increased in intensity, fre-
quency and/or duration. In the specific case of the elderly,
regular physical activity increases average life expectancy
through its influence on chronic disease development, through
the mitigation of age-related biological changes and their asso-
ciated effects on health and well-being, and through the presser-
vation of functional capacity (ACSM, 2009).
Spain ranks first among Europe countries in terms of physi-
cal inactivity per inhabitant, although interest in sport for exer-
cise, leisure and entertainment is on the rise. Moreover, the
elderly in Spain participate less in sports activities and/or
physical exercise programmes than the rest of the population
(Armstrong & Morgan, 1998; Dalloso, Morgan, Bassey et al.,
1998). In a study on sports habits in Spain conducted in the
year 2000 (García-Ferrando, 2001), individuals aged 65 - 74
were included in the study population and the sample, empiri-
cally demonstrating that 8 per cent of this age group partici-
pated in physical and sports activities (with the exception of
walking). In the most recent survey on sport-related habits
conducted in Spain (CSD-CIS, 2005), only 17 per cent of re-
spondents above the age of 65 stated that they practised sports
compared to 58 per cent of young people aged 15 - 24. In that
study, García Ferrando (García-Ferrando, 2006) points to in-
creased participation in sport among people over the age of 55
and believes that this increase is a significant change that merits
further study in a future survey. Similar participation rates were
observed in a recent Rand D&I study conducted in Spain on
physical activity among the elderly by Martínez (Martínez,
González, Jiménez-Beatty et al., 2009) using a representative
sample of the Spanish population. Martínez found that 19.6 per
cent of women and 14.8 per cent of men engage in one or more
physical or sports activities per week, while 92.2 per cent of
men and 81.9 per cent of women state that they go for walks
once or more a week.
The above data justify the objective of this article: to exam-
ine if participating in sport and physical activity influences
perceived health among the elderly and determine which activi-
ties contribute to better perceived health among them. To
achieve these aims, we have studied the elderly in Spain given
that, as mentioned above, the country is undergoing a marked
process of population ageing accompanied by a high rate of
Material and Methods
In order to perform the research, data was drawn from the
study titled “Deporte, Salud and Calidad de Vida” (Sport,
Health and Quality of Life, E-0727) conducted by the Institute
for Advanced Social Studies of the Spanish National Council
for Scientific Research (IESA-CSIC) through an agreement for
collaboration with the Obra Social la Caixa. A total of 2018
computer-assisted telephone (fixed and mobile) interviews
(CATI) were conducted using a structured questionnaire. The
questionnaire was administered to Spanish respondents aged 16
- 79 years old. The sample size was calculated in order to
gather information that was representative of different age
groups, with particular attention given to a subsample com-
prised of respondents aged 65 - 79 years old (804 interviews).
Sampling was stratified, with gender and age used as control
variables for the entire sample selected via mobile phones. In
addition to these two variables, the variables “province” and
“size of habitat” were used for the sample selected via fixed
lines. The distribution of the sample that was selected via fixed
or mobile phones was estimated by minimising the sample
variance. Finally, the assumed error level was ±3.5 per cent for
the group of respondents aged 65 - 79 years old. The data were
treated using SPSS 12.0 and 15.0 statistical software.
The research methodology comprised a bivariate analysis of
the individual’s perceived health and physical activity, which
was measured according to three variables: walking or strolling,
participation in sport, and daily physical activity. Variable as-
sociation analysis was performed using Pearson’s chi-square
test, which is presented alongside the analysis of typified re-
siduals for each category.
A dependency analysis (categorical regression) was then
performed with perceived health among the elderly as the de-
pendent variable and sociodemographic characteristics, physi-
cal activity and sport as independent variables. The co-influ-
ence of certain variables on others also affecting perceived
health status has shown that this method of analysis is appro-
priate as it accounts for the effect of each indicator on the de-
pendent variable, while the effects of the other variables remain
ceteris paribus. In this study, we have measured physical activ-
ity and sport among the elderly by means of three indicators:
Sport, which is measured as a function frequency and inten-
Walking or strolling, which denotes if the individual takes
brisk walks or strolls, their frequency and intensity (amount
of time dedicated to the activity), and
Daily activities, which are measured by means of categories
that best describe the individual’s situation regardless of the
main activity they engage in (work, household tasks, etc.)
while either remaining seated most of the day, standing but
not walking large distances or walking frequently.
Although walking and strolling or daily activities do not in-
volve as great an expenditure of energy as sport-related activity,
they do require physical exertion, which is very important at
this age. Due to the fact that health status in this age group is
closely associated to these particular activities, in this study we
consider walking, strolling or daily activities to be physical
activities. These three indicators will serve to determine to what
degree the elderly in Spain engage in an active lifestyle and the
influence these activities have on perceived health status. The
dependent variable “perceived health” was measured by means
of a 5-category Likert scale: “very good”, “good”, “neither
good nor poor”, “poor” and “very poor”.
Given that the dependent variable and the independent vari-
ables are not metric, but ordinal or nominal, is it not advisable
to perform classic regressions. For this reason, a categorical
regression analysis with optimal scaling was performed. In
general, this method functions in a similar way to classical
linear regression with the exception that the variables are
transformed by optimal scaling.
On the whole, the elderly in Spain believe that their health is
Copyright © 2013 SciRes.
R. SERRANO-DEL-ROSAL ET AL.
good or very good (49.9 per cent), while 30 per cent state that
their health is neither good nor poor and only 10.9 per cent
describe their health as being poor or very poor (see Table 1).
The large proportion of individuals of this age who perceive
their health in positive terms should come as no surprise. Simi-
lar studies (Atchley, 1999) have pointed to the accommodation
regarding what is commonly accepted as being “normal” or
“optimum” health at this stage of life. Indeed, when faced with
the same health problem, the elderly perceive themselves to be
healthier than younger individuals.
When asked the question “Do you think that your health is
better, worse or the same as other people of your same age and
sex?”, the respondents generally state that it is the same (26.9
per cent) or better (22.1 per cent), whereas only 7.6 per cent
think that their health is worse than their counterparts. None-
theless, the modal category “I don’t know” is the option chosen
by 35.8 per cent of elderly respondents. Furthermore, among
individuals who perceive themselves to have worse health than
individuals of the same age and sex, the majority believe that
their health is “poor” or “very poor”, thus indicating that the
responses are consistent.
When comparing current health status to the previous year,
the elderly do not perceive their health in such a positive man-
ner: 26.3 per cent believe that their health is worse or the same
(62.5 per cent), while only 11.1 per cent think that it is better
than one year ago. As in the previous case, the responses are
much more negative among those who perceive their health to
be “poor” or “very poor”.
It is also interesting to note that 68.7 per cent of the elderly
who were interviewed state that they suffer from pain or feel
discomfort in some part of their body. Accordingly, suffering
from pain is one of the variables that most influences perceived
health, with those who state they suffer pain also citing worse
In general, the elderly in Spain were found to be quite sed-
entary. 35.4 per cent never walk, 6.8 per cent walk only occa-
sionally, 6.5 per cent walk two or three times per week and half
of those interviewed state that they walk everyday. A much
lower proportion of elderly practise sports: 16 per cent practise
sports either everyday or two or three days a week, while 81.4
per cent practise no sports at all. Finally, when the respondents
were asked about the activities they engage in on a daily basis
(household tasks, leisure, etc.) 30 per cent state that they sit
most of the day, 36.3 per cent state that they spend most of the
day standing, while 29.9 per cent frequently walk.
As regards respondents’ assessment of sport and physical ac-
tivity, it is important to highlight that 95.1 per cent of the eld-
erly in Spain believe that these activities are “good for your
health”, while 90.2 per cent think that they “make you feel bet
Responses obtained per item on perceived health.
P1_6—As regards your health,
do you feel that it is…?
1) Very poor
3) Neither good nor poor
5) Very good
Note: Study E0727 IESA-CSIC. Base: percentage of cases.
ter about yourself”, that is, the majority believe that sport and
physical activity are beneficial to one’s overall well-being. In
contrast, less than 10 per cent of the respondents think that
sport and physical activity is “bad for your heart”, “worsens
your general state of health”, or is “bad for your bones”. How-
ever, a significant number of elderly individuals state that these
activities “cause anxiety” (26 per cent).
The relationship between overall health and an active life-
style is examined in this paper through the association between
the indicator “perceived health” and activities that involve some
type of physical exertion. Table 2 shows the values of each
variable in relation to health status, indicating whether or not
the differences are statistically significant and the value of the
typified residuals for each category of responses.
As can be seen in Table 2, walking or strolling have a posi-
tive effect on the subjective perception of health status among
the elderly, with worse health being observed among those who
never walk. As the typified residuals (see also Figure 1) dem-
onstrate, the categories that are most closely associated to
health are “don’t walk” and “walk everyday”. These are the two
categories in which they elderly most frequently classify them-
selves, with only a small proportion indicating that they walk
only occasionally or several days a week. The same thing oc-
Perceived health according to physical activity.
WALK OR STROLL
Poor or very
poor Fair Good or
Don’t walk 51.3%
Walk 2 or 3
times a week
Walk everyday 39.0%
SPORT (**) Poor or
very poor Fair Good or
Don’t do sports 91.1%
Do sports 2 or 3
times a week
Do sports everyday3.8%
ACTIVITY (**) Poor or very
poor Fair Good or
Note: Study E0727 IESA-CSIC. (**) indicates that the differences in subjective
health are statistically significant in this sample with p < 0.01. The information
that appears in the parenthesis below the percentages indicates the value of the
typified residuals for each value.
Copyright © 2013 SciRes. 153
R. SERRANO-DEL-ROSAL ET AL.
Typified residuals: Perceived health according to frequency and
intensity of walking or strolling. Source: Study E0727 IESA-CSIC.
curs among those who practise or do not practise sports: the
main differences are found between those who practise no
sports at all (80 per cent of the elderly) and the rest of the re-
spondents and those who practise no sports at all have poorer
perceived health. However, the greatest differences are ob-
served in the group that practises sports several times a week as
they have a positive opinion about their health. Finally, sitting
most of the day is related to poorer health status as compared to
walking or standing, although the most significant differences
in terms of perceived health status are found in the group that
spends most of the day sitting (see Figure 2).
As the bivariate analysis has shown, participating in some
type of physical activity or sport is beneficial for health and the
elderly who engage in such activities perceive their health in a
more positive manner than those who do not engage in them.
Nonetheless, as mentioned above, we have performed a regres-
sion analysis with all of the variables to obtain more solid con-
clusions (see Table 3).
More than 80 per cent of the elderly respondents state that
they do not engage in any type of sport-related activity, while
50 per cent walk or stroll everyday. Thus, although practising
sports is statistically significant with regard to how the elderly
perceive their health, sport is of little importance in relative
terms in comparison to the rest of the variables included in the
model. Among the variables associated with physical activity,
the most important ones in terms of perceived health in this age
group are daily activities followed by walking or strolling. In-
deed, the elderly point to the importance of not spending the
day sitting as it is easy to do so given that they have so many
free hours to occupy.
As regards the sociodemographic variables that influence
health status, gender is found to be the most important. This
variable explains 37.7 per cent of the total variability (R2) and
shows that women have poorer health than men. Income level
and educational level are also found to have an effect on per-
ceived health among the elderly. Both variables have a positive
sign, that is, the higher the income or educational level, the
better perceived health. Although the rest of the variables are
significant, they account for less than 4 per cent of the total
In contrast to physical inactivity (sendentariness), which is a
major health risk factor, physical activity is beneficial from a
physiological, psychological and social standpoint as self-re-
ported changes in health have shown.
Sport-related activities are not as widespread among the eld-
erly of Spain as they are among other groups, with only 16.2
Typified residuals: Perceived health according to daily activities.
Source: Study E0727 IESA-CSIC.
Regression analysis. Dependent variable (DV): Perceived health.
Independent variables (IV): Physical activities and sociodemographic
DV: Perceived health
B (SE) Imp
Walk or stroll 0.148 (0.038)** 15.5%
Sport 0.078 (0.037)* 2.7%
Activity 0.159 (0.038)** 16.3%
Sex −0.276 (0.044)** 37.7%
Marital status 0.070 (0.037)* 3.8%
Education level 0.112 (0.038)** 9.6%
Employment status −0.079 (0.042)* 3.4%
No. household members 0.152 (0.055)** 3.1%
Living situation −0.202 (0.056)** 2.9%
Income 0.097 (0.042)* 11.7%
Corrected R2 17.2%
Note: The following values are given for each variable: Beta coefficients (B),
standard error (SE) and statistical significance. Statistical significance is denoted
as follows: **significant at 99% (p < 0.001); *significant at 95% (p < 0.05). The
“Imp” column refers to Pratt’s Importance; a measure that indicates which vari-
able has the strongest influence on the dependent variable. This statistic is calcu-
lated by multiplying the regression coefficient of each variable by the correlation
with the dependent variable and dividing the result by the R2 of the model. The
sum of the importance of all the variables is 100. Finally, the R2 of the model is
given, that is, the percentage of explained variance (variability due to the vari-
ables used in the regression). Source: Study E0727 IESA-CSIC.
per cent stating that they engage in activities of this type on a
regular basis (several days a week or everyday). In contrast,
however, walking or strolling is a very popular physical activity
among a large proportion of elderly individuals (over 60 per
cent), with the majority engaging in this activity everyday (50.5
per cent). Nonetheless, the elderly in Spain lead a very seden-
tary lifestyle, with watching television being one of the main
activities they engage in during their free time (as this survey
According to the results of this study, practising sports has a
statistically significant effect on perceived health among people
in the 65 - 79 years old age group. However, the importance of
practising sports on the variability of self-perceived health is
Copyright © 2013 SciRes.
R. SERRANO-DEL-ROSAL ET AL.
negligible, with differences chiefly found between those who
practise sports and those who do not, while frequency does not
appear to have an influence on perceived health. This contrasts
with the American College of Sports Medicine which, basing
their findings on a continual cycle of activity-inactivity, postu-
lates that “more is better”; a factor that has proven to have no
effect in our study among the elderly.
The same does not hold for walking or strolling. These ac-
tivities were found to be significant and have a greater influ-
ence on perceived health than sport. Moderate physical activity
produces greater satisfaction with health among this age group
and is also easier to do (many more elderly individuals do
moderate physical activity). Indeed, it is common to see elderly
people walking alone or in groups in both rural and urban areas
for leisure purposes, health reasons or following physicians’
The activities that the elderly engage in on a daily basis
(walking, standing and walking short distances or sitting most
of the day) also have an influence on the way they perceive
their health. The elderly, who typically lead a more sedentary
lifestyle than the general population, attach greater importance
to keeping active and not remaining idle as a means to achiev-
ing better health.
In general, women show worse perceived health status than
men with statistically significant differences. Moreover, this
variable has the greatest importance in terms of perceived
health among the elderly (accounting for 37.7 per cent of the
explained variance—R2). These results are in line with conclu-
sions reached in other studies (Gonzalo & Pasarín, 2004;
Hoffmeister & Vallebuena, 2006). In addition, women have
generally been found to do the least amount of physical activity
in this and other research studies (Martínez, 2005). Engaging in
less physical activity could have a negative effect on perceived
health, while a negative view of one’s health could, in turn,
result in low participation in physical activity, thus leading to a
vicious cycle as Johnson and Wolinsky (Johnson & Wolinsky,
1993) have reported.
Income level is also found to affect perceived health status as
those who have higher incomes state that they are more satis-
fied with their health. The association between higher economic
levels and better health has already been studied and demon-
strated empirically in research on health inequalities (Raphael,
2006), and in studies on differences in physical activity due to
cultural and economic determinants (Moscoso & Moyano,
2009). Finally, it should be noted that elderly individuals with
higher educational levels cite better health; a finding that has
also been reported in studies on health inequalities due to so-
cioeconomic factors (Fernández, Clúa, Báez, Ramírez, & Prieto,
2000; Gonzalo & Pasarín, 2004; Gallegos-Carrillo & García-
Peña, 2006). The elderly women in our study (and in others
cited here) have lower educational and income levels than the
men, while a greater proportion are widows or live alone; fac-
tors that may also lead to poorer health.
Increased life expectancy and the decline in fertility in Spain
and other western countries are factors that have contributed to
rapid population ageing. The proportion of the population over
the age of 65 is on the rise, making this group the focus of
growing public concern. Due to the physiological deterioration
that accompanies this stage of life, many public policies are
oriented towards healthcare initiatives and measures to promote
healthy lifestyles among the elderly. Moreover, an ageing
population is more sedentary, thus affecting the physical and
mental processes of ageing. For this reason, health organisa-
tions recommend that the elderly engage in physical activity
and/or participate in sports activities to promote a broader con-
cept of health. Indeed, many of the messages directed at this
age group centre on the benefits of moderate activity such as
walking, swimming, cycling or others.
As we have shown in this paper, self-reported health among
the elderly in Spain is influenced by participation in moder-
ate-intensity aerobic physical activity, principally frequent
walking and strolling or daily activities. The claim that greater
health benefits can be gained through increasing the frequency,
intensity and duration of physical activity have not been con-
firmed for this age group, particularly when health is not meas-
ured in the biological sense of the term, but more broadly as
physical, mental and social well-being as defined by the World
A great number of sport and healthcare institutions empha-
sise that for physical exercise to be beneficial to health, it is
necessary to be physically active for a given duration, fre-
quency and intensity. However, according to our research, it is
more important for the elderly to feel that they are active, par-
ticularly during a stage of life in which society has declared
them to be legally “inactive”. In this sense, our results confirm
the WHO approach to promote active ageing, which includes
moderate physical activity and greater mobility when carrying
out daily activities (walking, climbing stairs, gardening, danc-
ing, swimming, etc.). In this same line, other authors also indi-
cate that “doing some type of physical activity is better than
doing nothing at all” (USDH, 2008; Blair, Kohl, Gordon, &
Paffenbarger, 1992) and that moderate exercise, which many
more people are able to do, may have important health benefits.
Thus, the functional capacity or the independence of elderly
individuals (that they feel and perceive themselves as people
who are not “dependent”) will, in many cases, determine how
they perceive their health or whether they define themselves as
being healthy or ill (Gonzalo & Pasarín, 2004). As this paper
has shown, engaging in activities that require movement and
mobility, be they household tasks, walking or strolling every-
day or practising a sport, are essential to their health.
In general, people believe that physical activity is beneficial
to health, but their words speak louder than their actions.
Moreover, as other studies have shown, poor health is cited as
one of the main reasons for not participating in physical activity
or sport. Although the message is loud and clear, it does not
mean that the elderly act accordingly. In fact, many are reluc-
tant to change their lifestyle patterns. This contradiction be-
tween “thought and action” has been reported by other authors
(Grant, 2001) who explain such behaviour as a result of the lack
of socialisation into physical activity during childhood, which
has long-lasting effects over time; external barriers to participa-
tion in physical activity or internal barriers such as one’s own
perception of health condition the type and intensity of exercise
that elderly individuals believe they can or cannot do. Accord-
ing to Grant, being aware of the benefits to be gained from
exercise is not sufficient to motivate the elderly to engage in
physical activity, but exercise must be valued in its own right.
In our opinion, this approach constitutes an enormous change in
how exercise is perceived and would require a greater effort by
public institutions to effectively promote active lifestyles
among the elderly. However, a less demanding message that
focuses on the importance of doing moderate exercise such as
walking or strolling does seem to have reached this age group.
Copyright © 2013 SciRes. 155
R. SERRANO-DEL-ROSAL ET AL.
Copyright © 2013 SciRes.
Perhaps this is the example to follow, especially if we assume
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shown, moderate exercise such as walking, or feeling that one
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