Facilitators and barriers to physical activity among older adults in Karachi – a qualitative exploratory study

Background: The global older adult population is expanding, projected to reach two billion by 2050. Pakistan, a low- and middle-income country (LMIC), is home to 7% of its older adult population (above 60). Physical inactivity is prevalent in this group, linked to chronic diseases and mental health disorders. However, little is known about its determinants. This study explores physical activity factors (facilitators and barriers) at individual, interpersonal, community, and policy levels among older adults in Karachi. Methods: A qualitative exploratory study was conducted in two Karachi districts using a purposive sampling. A total of 24 older adults aged 60 and above, with no physical limitations, were interviewed at their residences. Semi-structured interview guide informed by the socioecological model (SEM) was used. Data analysis followed Braun and Clark’s thematic analysis, using inductive deductive open coding. Results: Four themes corresponding to each level of the socioecological model were identified. At individual level, health benefits and use of technology were identified as the facilitators, while physical (e.g., joint pain), and psychological factors (e.g., low motivation), and resource limitations (e.g., time) were identified as barriers. At interpersonal level, support from children and grandchildren was identified as the facilitators, while social media influences (e.g., smartphones) were identified as a major barrier. At community-level facilitators identified include presence of community-based centers and peer groups while barriers include norms and attitudes (e.g., societal views), more so for women, which hinder participation, compounded with poor infrastructure, safety and security issues. At policy level, participants emphasized the need for dedicated spaces and policies promoting PA for older adults. Conclusion: This is one of the first studies from Pakistan diving deeper into key facilitators and barriers related to physical activity among older adults in Pakistan. Context-specific interventions should be designed to overcome these barriers while considering the prevailing environmental and cultural dynamics of Karachi. Findings can help the decision makers at the municipal level and health departments in shaping targeted interventions for health promotion and active ageing.