Older adults’ perceived capabilities for an active lifestyle in a rural german municipality: A cross-sectional study

BACKGROUND: Physical activity (PA) is essential for healthy ageing, yet older adults in rural areas face particular constraints. This study applied Amartya Sen's Capability Approach to examine how older adults in a rural German municipality perceive their opportunities for an active lifestyle and to identify factors associated with high PA engagement. METHODS: A cross-sectional total population survey was conducted in a rural municipality in Bavaria, Germany. All residents aged ≥60 years (N = 593) were invited by post. Perceived capabilities were assessed using an instrument grounded in the Capability Approach. High PA engagement was defined as being physically active for at least 30 minutes on ≥4 days per week. Multivariable logistic regression was used to identify associated factors; multiple imputation by chained equations was used as a sensitivity analysis. RESULTS: The response rate was 33.0% (N = 196); 166 respondents (84.7%) had complete data for the primary model. Mean age was 69.5 years (SD 7.6); 49.0% were men. Most participants (58.8%) rated their health as good, and 23.5% met the threshold for high PA engagement. Mean daily sedentary time was 6.12 hours (SD 3.37), higher in men than in women (6.64 vs 5.61 hours, p = 0.043). In the multivariable model, fewer perceived environmental opportunities were independently associated with lower odds of high PA engagement (OR 0.59 per SD, 95% CI 0.37-0.95), and poorer self-rated health showed a comparable association that did not reach conventional significance (OR 0.65 per SD, 95% CI 0.41-1.02). Under multiple imputation the association with poorer self-rated health was statistically significant (OR 0.60, 95% CI 0.38-0.94), as was male sex (OR 0.44, 95% CI 0.20-0.95), whereas the association with perceived environmental opportunities was no longer significant (OR 0.67, 95% CI 0.43-1.03). Age and social support were not associated with PA engagement. Living alone was associated with markedly lower perceived capabilities across several domains. CONCLUSIONS: Perceived environmental opportunities and health status, rather than information or social support, distinguished more from less active older adults in this rural setting. Capability-enhancing interventions should prioritise the built environment and should give particular attention to older adults living alone. Community-Based Participatory Research may help match provision to the capability sets of rural residents.