2011. Vol. 2, No. 1, 35-41
Copyright © 2011 SciRes. DOI:10.4236/psych.2011.21006
Gender Differences in the Relationships between Physical
Activity and the Psychological and Physical Self-Reported
Conditionof the Elderly in a Residential Care Facility
Emanuela Rabaglietti1, Monica Emma Liubicich2, Silvia Ciairano1,2
1Department of Psychology, University of Turin, Turin, Italy;
2Motor Science Research Center, SUISM (University School of Motor & Sport Sciences),
University of Turin, Turin, Italy.
Received November 23rd, 2010; revised December 13 rd, 2010; accepted December 28th, 2010.
The present study aimed to investigate the differences pre- and post-test after introducing an aerobic program of
physical activity in the psychological and physical self-reported condition (feelings of depression, perception
that one’s own health limits physical activities, negative self-perception, and execution of activities of daily liv-
ing) of a group of elderly Italians deemed to be slightly compromised based on the Mini Mental State Examina-
tion (MMSE: median 23) and living in a residential care facility in northern Italy. The self-reported measures
were drawn from the 36-Item Short Form Health Survey Questionnaire (SF-36), the Geriatric Depression Scale
(GDS), and the Italian short version of Scale of basic Activities of Daily Living (ADLs). The participants were
17 elderly people of both genders (10 women and 7 men), with a median age of 85.56 years. The findings (we
used non-parametric statistical techniques) showed that: 1) dropping activities/interests (due to feelings of de-
pression) and taking a bath/shower autonomously (from activities of daily living) improved in women; 2) per-
ceiving health as a limitation to moderate physical activity and feeling really down (based on negative
self-perception) improved in men. These results underscore the importance of considering gender differences
when evaluating the relationships between participation in physical activity and the psychological and physical
condition of the elderly.
Keywords: Elderly People, Training, Psychological and Physical Condition, Ge n de r Differences.
Demographic data and epidemiological studies have demon-
strated that the prolongation of the life span leads to increasing
disabilities in the oldest and frailest group of the population
(Aromaa & Koskinen, 2004; Stenzelius et al., 2005; WHO,
2002). However, data also indicate that this age group repre-
sents the fastest growing population group. The United Na-
tional Department of Economics and Social Affairs (United
Nation, 2009) reported that people older than 80 represent 1.5%
of the worldwide population; this proportion is expected to
increase to 4.3% by 2050. The same report also highlighted that
the current gender difference - namely, that elderly women
outnumber elderly men two to one - will disappear over time.
These universal tendencies will ultimately transform the role of
the elderly. However, the loss of autonomy together with the
increasing likelihood of disease that often accompanies aging
makes research into preventive and health promotion interven-
tions increasingly important as it may contribute to improving
seniors’ quality of life.
Several aspects remain unclear, especially with respect to
very old people and their institutionalization in residential care
facilities. Among all the other potential protective factors, we
are particularly interested in investigating the relationships
between physical activity and the psychological and physical
well-being of the elderly. Nevertheless, very few studies have
investigated gender differences among very old people or among
those in non-normative life conditions associated with residen-
tial care facilities. This lack of research likely stems from the
fact that currently the mean life expectancy among men is much
lower than that among women, making it difficult to constitute
groups of participants large enough to investigate the compari-
son between genders.
The life condition of the elderly institutionalized in residen-
tial care facilities is unique with respect to the general popula-
tion based on several indicators of psychological adjustment,
including depression. For instance, elderly people living in
residential care facilities have a higher probability of suffering
from different forms of depression than their same-aged peers
still living independently (Soondool, 2008). Concerning this,
Baltes and collaborators (Baltes, Maas, Wilms, Borchelt, &
Little, 1999) highlighted the controversial issue of causal rela-
tionship between depression and autonomy, suggesting that the
loss of autonomy constitutes the causal premise of the subse-
quent high level of depression. However, family support still
represents an important protective factor against the develop-
ment of depression even among the elderly in residential care
living conditions (Hendry & Reid, 2000; Kim & Yang, 2001).
Furthermore, depressive conditions, which concern about one
third of the general population older than 50 years, increase
exponentially with age and are much more common in women
than men (Bird & Parslow, 2002; Ell, 2006). Such depressive
conditions often become a primary cause of disabilities, indi-
vidual discomfort, high use of health services, and even suicide
(Steffens et al., 2000; Serby & Yu, 2003; Cole et al., 2006).
Changes in living conditions when the elderly are institu-
tionalized in residential care facilities, which thus far has af-
fected more women than men, represents a relevant challenge
for individuals’ well-being. An elderly person often loses inter-
est in things and activities not included in the immediate living
area. As such, the elderly seem to anchor themselves and/or
concentrate on the immediacy of the present, developing intol-
erance toward change and frustration as well as often sharply
reducing the range of social relationships while giving up
self-determination and autonomy (Cesa-Bianchi & Albanese,
2004). Thus, residential care facilities must offer environmental
conditions that help residents maintain and develop residual
skills. In these institutions the quality of care relationships is
much more important than the quality of care in general (Censi,
The research by Anstey, von Sanden, Hons, Sargent-Cox,
Hons and Luszcz (2007) on the passage from the normative
condition of independent living to living in residential care
facilities showed that this transition is very delicate. In fact,
during this transition, depressive symptoms increase before the
onset of physical and cognitive decline. Nevertheless, a high
interindividual variability occurs with respect to reactions dur-
ing this transition. Subjective well-being and self-concept were
shown to be more similar than expected in men and women as
well as strongly related to the economic and educational level
of individuals and their social networks (Pinquart & Sorensen,
Several studies have demonstrated that motor difficulties,
disabilities in mastering daily activities, and serious injuries are
risk factors that increase the likelihood of institutionalization
(Hirvensalo et al., 2000; Laukkanen et al., 2000; Agüero-Torres
et al., 2001; Rockwood et al., 2001). Conversely, a longitudinal
study by Farmer, Locke, Moscicki, Dannenberg, Larson, and
Radloff (Farmer et al., 1988) showed that constant physical
exercise reduces the risk of developing depression on the long
term. Furthermore, the adoption of active lifestyles - even at
advanced ages - fulfills the role of a general protective factor
for health in both genders (Camacho et al., 1991). A study in-
volving old people with depressive symptoms (Pennix et al.,
2002) found that, at a follow-up after 18 months, aerobic activ-
ity focused on walking reduced depression more efficiently
than other kinds of physical training focused on muscular
training for resistance.
With respect to gender differences, we found contrasting
previous findings. According to Stephens (Stephens, 1988), the
association between physical activity and psychological health is
stronger in women than men. This is also consistent with the
study of Smith and Baltes (Smith & Baltes, 1999) that through
cluster analysis showed as in most cases the less desirable pro-
files belong to women rather than to men. Meanwhile, Yanagita
et al. (2006) highlighted a strong correlation between physical
disability and depression in men. However, movement was
shown to be effective in improving motor skills useful for re-
maining independent as long as possible in the elderly of both
genders (Fried et al., 2004; Gill et al., 2004). Some studies
(Malbut-Shennan & Young, 1999; Sullivan et al., 2007) indi-
cated that participation in aerobic and resistance training may
achieve changes in the individual’s functioning in terms of
maintaining independence and reducing feelings of fatigue,
even in ver y ol d people of about 80 years.
Taking into account scientific evidence that has underlined
the strong relationship among decreased motor skills, worsened
health, and increased depression (Pennix et al., 1999), physical
activity may fulfill a relevant preventive role, especially when
the elderly person is in a condition of physical and/or psycho-
social frailty, against the underlying processes of both physical
and emotional discomfort. Health and skills for mastering daily
living are fundamental in the life of every person. However,
they become even more important for maintaining satisfactory
levels of quality of life during aging. Furthermore, the increas-
ing number of old people - including males - in reside ntial care
facilities suggests the need to investigate the presence of gender
differences in the relationship between physical activity, which
is a relatively cheap and easy to introduce training, and general
wellbeing also in order to make this training more efficient.
The Study
The present longitudinal study represents the continuation of
some our previous studies (Ciairano et al., 2010; Rabaglietti et
al., 2010) that already demonstrated the positive effect of an
aerobic program of physical activity on positive self-perception,
the perception that health limits physical activities, and physical
performance and condition among elderly Italian people in
residential care facilities. In the present study, we further ex-
tend our interest, focusing on the gender differences in the
psychological and physical self-reported conditions during pre-
and post-testing among a elderly group of people who partici-
pated in an aerobic activity. Specifically, we examined a group
of elderly living in a residential care facility and who were
shown to be slightly impaired according to the Mini Mental
State Examination (MMSE). The study aims to describe the
changes between the pre- and post-test separately in old men
and women and the gender differences at each wave for
self-reported psychological aspects (feelings of depression,
perception that one’s own health limits physical activities, and
negative self-perception) and physical aspects (execution of
activities of daily living).
Description of the Intervention
The intervention was introduced in a residential care facility
in northern Italy that is a private structure linked to public
health service through a funding agreement. This structure was
selected at random among all those present in the region. Par-
ticularly it was selected among those with a intermediate condi-
tion in terms of social and economical levels of the elderly.
This facility houses both self-sufficient (i.e., they can still walk,
eat, and go to the bathroom by themselves) and dependent (i.e.,
requiring assistance with essential activities of daily living)
elderly people. It also provides self-sufficient guests with a
daily physiotherapy session.
The intervention consisted of one 45-minute session per
week for 15 weeks (roughly 4 months). The intervention was
addressed to a group of self-sufficient older people living in a
residential care facility. The sessions were conducted by one
instructor who had a university degree in physical education
and sports-related fields and specialized in physical fitness
training for the elderly (Ciairano et al., 2006a; Ciairano et al.,
2006b). Particularly this instructor was selected among those
who (during the previous academic year) successfully passed
the subject of “Health and the elderly” getting a grade upper the
95% percentile of the grades distribution. The instructor re-
ceived a little reimbursement for the implementation of the
program of physical activity and he got the acknowledgment of
his activity as a kind of professional practicum.
The aerobic program aimed to achieve five main goals:
to improve respiratory function through deep breathing
to promote the awareness of incorrect or compensative
posture and to learn to modify these problems on one’s
to execute movements addressed to the various joints,
trying to reach the maximum possible exertion, without
exceeding personal limitations;
to reach a correct perception of one’s body in various
conditions of static and dynamic equilibrium; and
to strengthen interpersonal relationships and re disc over the
joys of “playing” and using abilities that may have been
perceived as lost by exercising in pairs or small groups.
The intervention was tailored to engage participants gradu-
ally and interest them in a variety of different kinds of activities,
using both conventional and unconventional instruments (e.g.,
stools, sticks, clubs, hoops, balloons, foam balls, towels, paper
cups, pins, bowls, paper tissues, scarves, and trays) as well as
stressing playful qualities. In addition, the instructor received
daily updates by other personnel regarding participants’ condi-
tions, including minor physical problems, in order to avoid
potentially dangerous movements. Furthermore, special care
was taken to provide participants wi th plenty of time to execut e
each movement, avoiding activities that could have been per-
ceived as too intens e, embarrassing, or difficult.
The director of the residential care facility, who is a trained
physician, selected the elderly people to participate in the aero-
bic program from among all those living in the facility. The two
criteria for inclusion were: 1) self-sufficiency (as previously
defined herein), and 2) absence of serious chronic and/or acute
diseases, which was verified directly by the researchers. The
MMSE was used to evaluate cognitive capacity (Folstein, Fol-
stein & McHugh, 1975). All participants were assessed as mild
cognitively impaired; the median score was 23, and the MMSE
tests scored ranged between 18 and 24. The participants were
informed that participation in the study was voluntary and con-
fidential. All those selected agreed to participate and gave in-
formed consent, in accordance with Italian law and the Asso-
ciation of Italian Psychologists’ ethical code (A.I.P., 1997).
The group of participants comprised 17 elderly people, in-
cluding 7 (41%) men and 10 (59%) women. The median age
was 85.00 years (Mean = 85.23, SD = 6.05; range 74-96). All
participants were permanent residents of the residential care
facility. All except one, who was born in the center of Italy,
were from the same region in which the facility is located. With
regard to marriage status, the majority (N = 10, 59%) were
widows, 29% (N = 5) were married, and the remaining had
never been married (N = 1) or were divorced (N = 1). In terms
of education, two levels were considered: ‘low’ corresponding
to compulsory education (primary and secondary school), and
‘high,’ corresponding to additional non-compulsory education
(including high school and university). The average level of
education for both men and women in the sample was similar at
the national statistics of age-matched population (ISTAT, 2006;
Costa, Migliardi & Gnavi, 2006). Among participants, 65% (N
= 11) had received compulsory education compared to about
70% in the national population. Former occupations were di-
chotomized into manual (N = 12, 71%) and non-manual labor
(N = 5, 29%). This ratio closely reflects the national population.
In addition, 53% (N = 9) had never participated in organized
exercise or sport activities. Of those who had (N = 8, 47%), the
preferred sports were bowling, gymnastics, soccer, and walking.
No gender differences emerged with respect to age (U
Mann-Whitney = 29.00, p = 0.91), former occupation (2
3.57, d. f. = 3, p = 0.31), or level of education (2
= 0.71, d.f.
= 1, p = 0.79). However, a difference did exist with respect to
marital status (2
= 7.09, d. f. = 3, p < 0.03): Women were
more likely to be widowed than men (80% vs. 17%), while men
were more likely to be married than women (50% vs. 20%). In
addition, the two persons who were not married (i.e., never
married or divorced) were both men.
We selected two questions from the Italian version of the
36-Item Short Form Health Survey Questionnaire (SF-36)
(Apolone & Moscone, 1998; Ware & Sherbourne, 1992). The
first investigates the perception of limitation to moderate phys-
ical activity according to one’s own health (How much your
health limit you in Moderate activities, such as moving a table,
pushing a vacuum cleaner, bowling, or riding a bicycle range
of possible answers: 1 “not at all” - 3 “much”). The second
investigates how many times in the last four weeks the person
has felt really down (Have you felt so down in the dumps that
nothing could cheer you up? range of possible answers: 1
“never” - 3 “always”). Participants also answered a question
from the Italian short version of the Geriatric Depression Scale
(GDS) (Segulin & Deponte, 2007; Yesavage et al., 1983): Have
you dropped many of your activities and interests? It had a
dichotomous answer: 0 “no”, 1 “yes.” Finally, we used a ques-
tion from the Italian short version of the Scale of basic Activi-
ties of Daily Living (ADLs) (Inzitari et al., 2006; Katz et al.,
1963) to investigate the autonomy in taking a bath / shower (To
go to toilet room, to use toilet, to arrange clothes, and to return
without any assistance. This question has dichotomous answers:
1 “by oneself, no help”, 0 “with help”). All measures were col-
lected by specially trained researchers.
Strategy of Analysis
We used the Wilcoxon test for dependent samples for ana-
lyzing the presence of differences between pre- and post-testing
in the sub-groups of men and women (see Table 1). To evaluate
the effectiveness of the intervention, we calculated the width of
a non-parametric effect size, which is more appropriate with
very little samples than other kinds of measures (Valentine &
Cooper, 2003). We also used the Mann-Whitney test for inde-
pendent samples to analyze the presence of differences between
men and women separately at each time (see Table 2). Finally , in
all cases, we described our data using both median (which may be
Table 1.
Wilcoxon test for dependent sample s on p s ychological indicators of adjustment – differe nces between pre and post-test.
Variable Z N Sig.1 Effect size Median Means (St. dev.)
(ES) Pre-test Post-test Pre-test Post-test
SF36-Perceiving health as limitation
for moderate activity-men –1.890 7 0.06 0,51 3.00 2.00 2.57 (0.79) 1.86 (0.89)
SF36- Perceiving health as limitation
for moderate activity-wome n –1.134 10 0.66 0,20 2.0 2.50 2.30 (0.82) 2.40 (0.69)
SF36-Fee lin g really down-men –1.633 7 0.10 0,44 3.00 2.00 3.00 (0.73) 1.86 (0.90)
SF36- Fee ling really down-women –0.07 10 0.94 0,02 2.80 2.50 2.80 (1.23) 2.90 (1.66)
GDS-Dropping activities and/or
interest-men (1 = yes; 0 = no) –1.000 7 0.32 0,27 1 1 0.57 (0.53) 0.71 (0.49)
GDS-Dropping activities and / or
interest-women –2.000 10 0.05 0,45 0.50 0.0 0.50 (0.53) 0.10 (0.32)
BADL-Taking a bath/shower auto-
nomously-men (1 = yes; 0 = no) -0.0 00 7 0.99 0,00 1 1 0.71 (0.49) 0.71 (0.49)
BADL-Taking a bath/shower auto-
nomously-women –1.414 10 0.10 0,32 0.0 1 0.40 (0.52) 0.60 (0.52)
1 We considered significance till p < 0.10 because of the very little sample size.
Table 2.
Mann-whitney test for independent samples on psychological indicators of adjustm e nt – g ender differences at pre-test and post-test.
Variable U N Sig.2
SF36-Perceiving health as limitation for moderate activity; pre-test 25.50 17 0.59
SF36-Perceiving health as limitation for moderate activity; post-test 15.00 17 0.08
SF36-Fee ling re a lly down; pre -te st 28.50 17 0.86
SF36-Fee ling re a lly down; pos t-te st 18.50 17 0.20
GDS-Dropping activities and/or interest; pre-te st 30.00 17 0.99
GDS-Dropping act ivities and/or interest; post-test 13.00 17 0.02
BADL-Taking a bath/shower autonomously; pre-test 17.00 17 0.10
BADL-Taking a bath/shower autonomously; post-test 23.00 17 0.35
2 We did not report in Table 2 the descriptive values (mean, median and standard deviation) because they are included in Table 1. 2 We considered significance ti ll p < 0 .10
because of the very lit tle sample size.
more adequate than other descriptive measures in a very little
sample) and mean as well as standard deviation.
Men significantly decreased the perception that their health
represents a limitation for moderate physical activity between
the pre- and post-test (see Table 1). In addition, men who did
not differ from women at the pre-test became more positive
than their female counterparts at the post-test (see Table 2).
Men also indicated a significant decrease in recent feelings of
being down between the pre- and post-test (see Table 1). How-
ever, men and women did not significantly differ at either the
pre- or post-test in the variable (see Table 2).
Women significantly decreased their perception of having
dropped activity/interest between the pre- and post-test (see
Table 1) and also showed a significant difference from men at
the post-test (see Table 2). Furthermore, women significantly
increased their autonomy in taking a bath/shower between pre-
and post-test (see Table 1). In other words, women showed
more similar results to men for this behavior at the post-test (at
the pre-test men were more autonomous than women; (see Ta-
ble 2).
Finally, the effect size of the intervention in relation to statis-
tically significant differences may be considered to be me-
dium-large in general.
Discussion and Conclusion
The study aimed to describe the relationships between the
participation in a program of physical activity, delivered by one
specially trained instructor, among a group of elderly Italian
people living in a residential care facility. In particular, the
study sough to investigate any changes between the pre- and
post-test as well as the gender differences for self-reported
psychological aspects (i.e., feelings of depression, perception
that one’s own health limits physical activities, and negative
self-perception) and physical aspects (i.e., execution of activi-
ties of daily living).
The study identified three main sets of descriptive findings.
First, we found that at the pre-test, some symptoms of depres-
sion, negative self-evaluation, and lack of autonomy in abilities
of daily living were similarly present in both genders. Men
were slightly more likely than women to take a shower/bath
independently at the pre-test. However, we do not know if the
particular condition of psychological and physical frailty is the
cause and/or the outcome of their living condition in a residen-
tial care facility. In order to further clarify this point, we would
need data before and after institutionalization. What we high-
lighted with this finding is that - in the living conditions in a
residential care facility and at a very old age - men and women
seem much more similar than was expected based on previous
studies among the independently living population (Angst et al.,
2002), which tend to find a higher proportion of women in
comparison to men showing symptoms of psychological dis-
comfort, if not depressive symptoms.
A second relevant issue is that the program of physical activ-
ity had some powerful effects on the psychological and physi-
cal condition of participants, mostly in terms of maintaining the
pre-test condition rather than improving. These findings con-
firm what we already concluded in previous studies (Ciairano,
et al., 2010; Rabaglietti et al., 2010). To change th e self-perception
of the elderly living in residential care facilities is very difficult.
Our participants already suffered great many limitations to their
autonomy. Furthermore, very old people - especially those who
already show at least mild cognitive impairment - may find it
difficult to cognitively detect and report on little changes in
their psychological and physical conditions. Given the frailty of
our participants, registering that they did not become worse
over time may be considered a success of the intervention.
However, we lack a comparable control group to be able to
claim this phenomenon as a positive effect of the participation
in the physical activity.
Third, the specific kind of analyses we performed in the pre-
sent study enabled us to move one step further from one our
previous study (Rabaglietti et al., 2010), in which we found that
depression was substantially stable between pre- and post-test
periods. This finding seemed to contradict what other scholars
have found. For instance, McMurdo and Rennie (McMurdo &
Rennie, 1993), albeit with younger samples than our study,
found a positive effect of physical activity on depression in
older people. Going more in-depth by analyzing singularly
different indicators of psychological discomfort, we found that
- despite a similar initial condition - the participation in the
physical activity might affect the well-being of the elderly dif-
ferently in relation to gender. Men decreased both the percep-
tion that their health is a limitation to their activity and the per-
ception of feeling really down, becoming better adjusted than
women at the post-test. Women decreased their dropping of
interest and activity while also improving their skills to master
independent living - an important ability of daily living (e.g.,
taking a bath/shower), becoming better adjusted than men at the
We certainly need to investigate such differences further.
However, at this stage of the research, we can interpret our
findings by reflecting on the great differences in socialization
processes that the present cohort of elderly experienced. To
support our interpretation we can also refer to the study by
Fortuijn et al. (2006), from the ESAW Study (2010). Accord-
ingly to this study gender differences are more prominent in
Italy than in others countries perhaps because of differential
educational processes. We have to acknowledge that this popu-
lation lived a completely different life as either a man or a
woman. Given that the participants were approximately 85
years old, they were born around 1925, when all western socie-
ties clearly segregated the tasks of men and women as well as
the goals for them to accomplish. Usually men were responsible
for the financial well-being of their families and they were not
involved in any kind of daily care. In other words, they were
almost completely dependent on their wives for the satisfaction
of basic needs, such as chores and hygiene. Conversely women
usually did not work outside the home, devoting their lives to
the daily care of their husbands, children, and other relatives.
This reflection may help explain something of the underlying
processes of changes introduced by a program of physical ac-
tivity. The intervention seems to affect what is more important
for the two genders. The perception of being limited in an ac-
tivity not directly involved in daily care (e.g., climbing stairs
and carrying items) might be important for men whereas the
skill of mastering independence in one of the few aspects of
daily care allowed in residential care facility (i.e., taking a
shower and/or bath) might be more important for women. Fur-
thermore, the training seems to positively affect the fact that
women become less likely to drop their interests and activities.
This study has several limitations. Among the most impor-
tant is the small sample size and lack of a equivalent control
group. These limitations do not allow us to generalize our find-
ings to different situations and populations. Furthermore, we
failed to consider relevant and objective clinical parameters,
such as blood pressure and other biochemical parameters.
Despite these and other limitations, our findings are relevant
as they suggest that even moderate physical training may con-
tribute - at least in the short term (Bij, Laurant & Wensing,
2002) - to ameliorating the psychological discomfort of the
elderly, who are at risk of developing serious injuries and gen-
eral disabilities precisely due to their low levels of activity and
high levels of discomfort (Heyward, 2004). Even a little ex-
perience in movement may start changing processes. Ultimately,
our findings suggest, such as highlighted also by Baltes and
colleagues (Baltes et al., 1999) about the possibility of improv-
ing well-being in old age, the need to look more carefully at
gender differences in the underlying mechanisms leading eld-
erly men and women to higher or lower levels of risk and to
collocate the present condition in the whole life history.
The authors wants to acknowledge the contribution of Re-
gione Piemonte, Direzione Sanità, Settore Igiene, and Sanità
Pubblica to this study.
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