Open Access Research article

Which older people decline participation in a primary care trial of physical activity and why: insights from a mixed methods approach

Annabelle Rogers1, Tess Harris1, Christina Victor2*, Alison Woodcock3, Elizabeth Limb1, Sally Kerry4, Steve Iliffe5, Peter Whincup1, Ulf Ekelund67, Carole Beighton8, Michael Ussher1, Fredrika Adams1 and Derek G Cook1

Author Affiliations

1 Population Health Research Institute, St George’s University of London, London SW17 ORE, UK

2 Gerontology and Health Services Research Unit, Brunel University, London UB8 3PH, UK

3 Psychology Department, Royal Holloway, University of London, London TW20 OEX, UK

4 Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London E12AT, UK

5 Department of Population Health Sciences, University College, London NW3 2PF, UK

6 MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 OQQ, UK

7 Department of Sport Medicine, Norwegian School of Sport Sciences, PO Box 4014, 0806, Oslo, Norway

8 Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK

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BMC Geriatrics 2014, 14:46  doi:10.1186/1471-2318-14-46

Published: 12 April 2014



Physical activity is of vital importance to older peoples’ health. Physical activity intervention studies with older people often have low recruitment, yet little is known about non-participants.


Patients aged 60–74 years from three UK general practices were invited to participate in a nurse-supported pedometer-based walking intervention. Demographic characteristics of 298 participants and 690 non-participants were compared. Health status and physical activity of 298 participants and 183 non-participants who completed a survey were compared using age, sex adjusted odds ratios (OR) (95% confidence intervals). 15 non-participants were interviewed to explore perceived barriers to participation.


Recruitment was 30% (298/988). Participants were more likely than non-participants to be female (54% v 47%; p = 0.04) and to live in affluent postcodes (73% v 62% in top quintile; p < 0.001). Participants were more likely than non-participants who completed the survey to have an occupational pension OR 2.06 (1.35-3.13), a limiting longstanding illness OR 1.72 (1.05-2.79) and less likely to report being active OR 0.55 (0.33-0.93) or walking fast OR 0.56 (0.37-0.84). Interviewees supported general practice-based physical activity studies, particularly walking, but barriers to participation included: already sufficiently active, reluctance to walk alone or at night, physical symptoms, depression, time constraints, trial equipment and duration.


Gender and deprivation differences suggest some selection bias. However, trial participants reported more health problems and lower activity than non-participants who completed the survey, suggesting appropriate trial selection in a general practice population. Non-participant interviewees indicated that shorter interventions, addressing physical symptoms and promoting confidence in pursuing physical activity, might increase trial recruitment and uptake of practice-based physical activity endeavours.

Physical activity; Non-participation; Primary care; Older people; Recruitment