Aging Anxiety and Physical Activity Outcomes among Middle and Older Age African Americans

Full text

RESEARCH
CORRESPONDING AUTHOR:
Lillie Monroe-Lord
College of Agriculture,
Urban Sustainability, and
Environmental Sciences,
University of the District
of Columbia, Washington,
DC 20008, USA
lmonroelord@udc.edu
KEYWORDS:
aging anxiety; physical activity;
gender; African American;
middle-age; older adults
TO CITE THIS ARTICLE:
Monroe-Lord, L., Harrison, E.,
Ardakani, A., Francis, S. L., Xu,
F., Marra, M. V., Weidauer, L.,
Arthur, A. E., & Sahyoun, N.
R. (2023). Aging Anxiety and
Physical Activity Outcomes
among Middle and Older Age
African Americans. Physical
Activity and Health, 7(1), pp.
281–292. DOI: https://doi.
org/10.5334/paah.287
Aging Anxiety and Physical
Activity Outcomes among
Middle and Older Age
African Americans
LILLIE MONROE-LORD
ELGLORIA HARRISON
AZAM ARDAKANI
SARAH L. FRANCIS
FURONG XU
MELISSA VENTURA MARRA
LEE WEIDAUER
ANNA E. ARTHUR
NADINE R. SAHYOUN
ABSTRACT
Aging is a natural process but may lead to aging anxiety due to physical and mental
health changes. Aging anxiety is more prevalent among African Americans compared
to Whites. This study aimed to investigate the correlation between aging anxiety, its
four constructs including fear of older adults (contact with older adults), psychological
concerns (personal/internal issues), physical appearance (physical changes), and fear
of loss (loss of autonomy and social relationships), with the different types of physical
activity (PA), as well as the attitudes toward PA. A total of 178 African American
adults aged 40 years and older completed an online Qualtrics survey. The Lasher and
Faulkender survey was utilized for the purposes of obtaining data on aging anxiety.
PA was measured using questions derived from the National Health Interview Survey
questionnaire and miscellaneous Questions for PA attitudes. The results revealed that
fear of loss was the most anxiety-inducing factor among the participants. Females
were more fearful of older adults and more anxious about aging than males. Possessing
an enjoyable attitude toward PA was associated with less fear of older adults, fewer
psychological concerns, and a lower total score of aging anxiety. Physical appearance
constructs were correlated with age and strengthening exercises. Younger participants
were more worried about their appearance than older participants. Fear of loss was
higher among single and lower-income participants. Interventions and mental health
programs should consider addressing the fear of loss and promoting a positive attitude
toward PA to alleviate aging anxiety among middle-aged and older African Americans.
*Author affiliations can be found in the back matter of this article

282Monroe-Lord et al.
Physical Activity and
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DOI: 10.5334/paah.287
1. INTRODUCTION
Aging anxiety, defined as fears and concerns regarding aging, is related to different psychological
outcomes, including concerns regarding the future, loneliness, and depression (Ayalon 2018;
Bergman and Segak-Karpas 2018; Bergman and Segak-Karpas 2021). Four interpretable
factors, including; fear of older adults, psychological concerns, physical appearance, and fear of
loss of autonomy and social relationships, are identified as principles of aging anxiety by Lasher
and Faulkender (1993). The majority of previous studies regarding aging anxiety focused on
younger and older adult populations, and there are limited studies for middle-aged adults
(Bergman and Segak-Karpas 2021). Lynch et al. (2000) showed that aging anxiety tends to
decline throughout life because of gradual adaptation to age-related limitations. The higher
rates of aging anxiety in middle-aged adults might result from an individual’s experience of
age-related changes. It’s important to note that an individual’s attitude towards aging can act
as either a protective factor or a harmful agent for their health status (WHO, 2016). Positive
attitudes and optimism about aging result in more health-promoting behaviors, such as
physical and social activity (Keyes and Weterhof 2012; Doyle, McKee and Sherriff 2012). In
contrast, a negative attitude and pessimism are linked to poorer physical and psychological
health (Brunton and Scott, 2015; Swift et al. 2017).
Aging anxiety levels vary among people of different races and ethnicities. Aging anxiety is
associated with negative stereotypes of older adults and is more common among the African
American population when compared to their White counterparts (Foos, Clark and Terrell, 2006;
Levy et al. 2007). Compared to their non-Hispanic White counterparts with a prevalence rate of
23%, the non-Hispanic Black population has a higher prevalence rate of physical inactivity at
30% (CDC, 2022). The African American population is also less likely to mention physical activity
(PA), which is defined as any physical motion generated by skeletal muscles that necessitates
the utilization of energy , and nutrition as essential elements of healthy aging than those of the
White demographic (Corwin, 2009; Piggin, 2020). African American women, however, are less
likely than White women to be concerned with body size and body image and are less likely to
fear age-related changes in physical appearance (Sabik, 2013).
PA plays a significant role as a key contributor to achieving successful “healthy aging,”
encompassing a wide range of clinical, psychological, and social benefits (Bauman et al. 2016).
The African American population is at disproportionately higher risk of hypertension, glucose
abnormalities, cancer, type 2 diabetes mellitus, and obesity compared to other racial/ethnic
groups (Kirkendoll et al. 2010). They are also less likely to receive treatment for their health issues
(Bland and Sharma, 2017). It is well documented that PA can reduce the risk of hypertension
and diabetes; furthermore, African Americans are also more likely to report physical inactivity
during leisure time than Whites (Crespo et al. 2000; Marshall et al. 2007; Joseph et al. 2015).
African Americans more frequently note physical/built and sociocultural environmental barriers
to PA, including lack of access to exercise facilities, environmental safety concerns, lack of
monetary resources, and a lack of leisure time (Han et al. 2011). Recognizing and addressing
these challenges are crucial steps towards promoting physical activity and combating aging
anxiety within the African American population. Moreover, the cultural relevance of physical
activity programs can play a significant role in encouraging participation. Studies have shown
that culturally tailored interventions and community-based programs focusing on physical
activity can be effective in engaging African American populations (Burkart, Laurent, Alhassan,
2017; Mumba et al. 2021).
There is a gap in the literature examining the impact of PA among persons of color, especially
African Americans, and their attitudes toward PA, type of exercise they most enjoy doing, and
most vulnerable demographic populations on aging anxiety. Our research aimed to contribute
to closing that gap and inform future policies that may protect and nourish the well-being
of African American society. Thus, in this study, we aim to 1) investigate the relationship
between aging anxiety and its constructs (fear of older adults, psychological concerns, physical
appearance, and fear of loss) and, engagement in the different types of PA, and 2) attitudes
toward PA among African American adults ages 40 years and over. The findings of this study
will contribute to developing educational sessions to reduce anxiety, determine the most
effective types of PA, and explore how to change individual attitudes toward PA to face aging
with more ease.

283Monroe-Lord et al.
Physical Activity and
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DOI: 10.5334/paah.287
2. METHODS
2.1. RESEARCH DESIGN, PARTICIPANTS, AND PROCEDURE
In this cross-sectional design, a sample of 178 African American middle and older age adults
(retrieved from a larger sample size of 1,250 community-residing adults of all races) aged
40 years and beyond were recruited online via Qualtrics to answer a 142 questions. The
data collection was performed between September and November 2020 in six states: Iowa,
Illinois, Maryland, Rhode Island, South Dakota, and West Virginia as well as Washington D.C.
Respondents for the study were selected from Qualtrics™ market research panels based on
their ability to read, understand, and respond to survey questions, as well as their internet
access. Panel managers followed random selection procedures to ensure a representative
sample, oversampling for age (targeting 70% ages 51 to 74) and race (targeting 40% Black,
Indigenous, and Persons of Color based on census data) (US Census Bureau 2019; Wong et al.
2022; Kendall et al. 2023).
2.2. SURVEY
The survey was composed of validated and reliable survey tools. In this study, we used part
of the collected data that concerned sociodemographic attributes, aging anxiety (measured
using Lasher and Faulkender’s 1993 scale), attitudes toward physical activity (PA) as reported
by Ajzen in 1991, and PA participation data obtained from the National Health Interview Survey
Questionnaire.
2.2.1. Physical Activity
The six questions concerning attitudes toward PA were designed based on the Theory of Planned
Behavior (Ajzen 1991). The first three questions evaluated the respondents’ affective attitude
by assessing their level of enjoyment of participating in PA (e.g., PA is enjoyable/unenjoyable,
interesting/boring, and pleasant/unpleasant) (Ajzen 2019). The next three questions assessed
the respondents’ instrumental attitudes by concentrating on the perceived advantages and
disadvantages of being physically active (e.g., PA is useful/useless, healthy/unhealthy, and
good/bad). These questions were designed using a 7-point Likert scale with a lower score
reflecting positive attitudes toward PA (i.e., 1 = positive attitude to 7 = negative attitude) (Ajzen
2019). The total attitude scores were calculated for each participant as well.
The second part of the PA practice survey was derived from the National Health Interview Survey
Questionnaire. The respondents answered questions regarding their intention to be physically
active and to participate in general PA, strengthening exercises, and stretching exercises using a
5-point Likert scale (1 = not likely at all to 5 = very likely) and a 9-point Likert scale for the other
three PA questions (i.e., 0 = 0 days to 7 = 7 days) (CDC 2017). Those participants that selected “I
am unable to do this type of activity” were considered to be at 0 days in the analysis.
2.2.2. Aging Anxiety Scale
The aging anxiety scale developed by Lasher and Faulkender (1993), was utilized in this study.
This validated survey was composed of 20 items that evaluated the four factors of aging
anxiety: Fear of older adults (measures external contact with older adults), psychological
concerns (measures personal/internal issues), physical appearance (reflects anxiety due to
physical changes caused by aging), and fear of loss (relates to loss of autonomy and social
relationships). This instrument used a 5-point Likert scale ranging from strongly disagree to
strongly agree (Lasher and Faulkender 1993). The scale possesses high internal consistency; in
addition, it must be noted that a higher score shows a higher level of anxiety. Anxiety constructs
were categorized as above or below the study population median for use in multivariable
logistic regression models.
2.2.3. Demographics
The demographics information collected to elaborate sample characteristics were: gender
(male, female, other), age (years), education (high school or less, more than high school),
marital status (single, married), residence location (rural, suburban, and urban), ethnicity,
and annual income. Self-reported height and weight were also collected from participants

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to calculate body mass index (BMI) which was used to define participants’ weight status
(underweight, normal, overweight and obese) (CDC 2022).
2.3. STATISTICAL ANALYSIS
Descriptive statistics were calculated for all variables. Wilcoxon rank sum tests were utilized
to test the relationships of aging anxiety and PA measures with the demographic variables.
Moreover, Spearman correlations assessed the relationship between aging anxiety and PA
measures. A stepwise multivariable logistic regression analysis was used to examine the
relationship between aging anxiety constructs, total aging anxiety score, and, the different
types of PA and attitudes toward PA. The models controlled for age, gender, education, income,
location of residence, marital status, BMI, and different attitudes toward PA, and actual PA
categories. SAS 9.4 (SAS Institute Inc, Cary, NC, USA) was used for statistical analyses. The
results were considered significant at p < 0.05.
3. RESULTS
3.1 DEMOGRAPHIC ANALYSIS
Most participants were female (62.3%), age 60 years or older (mean age = 61.5 years). Nearly
three out of four (73.6%) possessed more than a high school education, and 67% were single.
About 67% of the participants had an annual income less than $50,000. Additionally, about
50% of participants lived in urban areas. The mean BMI was 30.2 kg/m2, and approximately
74% of the participants were classified as overweight or obese (Table 1).
Table 1 Sociodemographic
characteristics of middle and
older age of African American.
Note: 1Never married,
widowed, divorced, separated,
BMI = body mass index.
CHARACTERISTICS
N
(%) MEAN (SD)
Gender
Female 111 (62.36)
Male 64 (35.96)
Other 3 (1.69)
Age (years) 61.5 (11.4)
40–49 30 (16.95)
50–59 42 (23.73)
60–69 59 (33.33)
70+ 46 (25.99)
Education
High school or less 47 (26.40)
More than high school 131 (73.60)
Marital status
Single1120 (67.24)
Married 58 (32.58)
Location of residence
City 90 (50.56)
Rural 19 (10.67)
Suburb 69 (38.76)
Ethnicity
Non-Hispanic/Latino 169 (94.94)
Hispanic/Latino 9 (5.06)
Income (USD)
≤20,000 57 (32.57)
20,001–30,000 30 (17.14)
30,001–50,000 30 (17.14)
>50,000 58 (33.14)
Weight status 30.2 (7.4)
Underweight (BM I2< 18.5 kg/m2) 6 (3.37)
Normal (18.5 kg/m < BMI < 24.9 kg/m2) 40 (22.47)
Overweight (25 kg/m2 ≤ BMI < 29.9 kg/m2) 55 (30.90)
Obese (BMI ≥30 kg/m2) 77 (43.26)

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DOI: 10.5334/paah.287
The highest score of the aging anxiety constructs was the fear of older adults (mean = 19.1),
followed by psychological concerns (mean = 18.2), physical appearance (mean = 17.3), and fear
of loss (mean = 10.9). Furthermore, the total score of aging anxiety among African Americans
was 65.44 (Table 2).
The higher PA by African Americans was related to doing daily general activities (e.g., walking
for at least 10 min at a time for fun, relaxation, exercise, or to walk the dog) rather than
strengthening and stretching exercises. The participants’ attitudes toward PA were mostly
related to their understanding of the advantages/disadvantages of PA rather than finding PA to
be an enjoyable activity (Table 3).
Among the different aging anxiety constructs, psychological concerns were significantly
different between sex/gender, with females being more concerned (p = 0.0063). In addition,
fear of loss was significantly related to the marital status and income level of the African
American participants (p = 0.0435 and p = 0.0401, respectively). Aging anxiety was higher
among married participants with more income than single participants with lower income.
Additionally total score of aging anxiety was simply related to the gender of the participant,
among other different sociodemographic variables. Female participants possessed a lower
mean aging anxiety score in comparison to their male counterparts, meaning that females are
more anxious about aging. The details of the finding reported in Table 4.
Table 5 reports the correlation between PA intention and the actual PA that was performed
by the African American participants, the different aging anxiety constructs, and total aging
anxiety. The intention to perform PA for 30 min per day for at least three days per week was
positively correlated with a fear of older adults (p = 0.0038). However, performing strengthening
activities was negatively correlated with physical appearance (p = 0.0126). The total score
of aging anxiety was positively correlated to the intention of participating in PA and general
activities (p = 0.0435 and 0.0401, respectively).
Table 2 Characteristics of
aging anxiety constructs
of middle- and older- aged
African Americans.
Note: SD = standard deviation.
5-point Likert scale (strongly
disagree to strongly agree)
measuring aging anxiety, with
higher scores indicating higher
anxiety levels (Lasher and
Faulkender 1993).
AGING ANXIETY CONSTRUCTS MEAN (SD) MEDIAN
Fear of older adults 19.10 (3.23) (Min. = 11, Max. =25) 19
Psychological concerns 18.15 (2.55) (Min. = 9, Max. =25) 18
Physical appearance 17.27 (3.07) (Min. = 10, Max. =25) 17
Fear of loss 10.92 (3.93) (Min. = 5, Max. =25) 11
Total score of aging anxiety 65.44 (7.87) (Min. = 51, Max. =100) 65
Table 3 Characteristics of
actual PA and attitude toward
PA of middle- and older-aged
African Americans.
Note: 1I intend to perform PA for
30 min/day for at least 3 days/
week over the next 2 months
(future). 2During the past seven
days, on how many days did you
walk for at least 10 min at a time
for fun, relaxation, exercise, or to
walk the dog? 3How many times
per week do you do physical
activities specifically designed
to strengthen your muscles
such as lifting weights or doing
calisthenics (e.g., exercising
large muscle groups)? 4How
many times per week do you
do physical activities designed
to stretch your muscles, such as
yoga or exercises like bending
side-to-side, toe-touching, and
leg stretches? 5-point Likert scale
(1 = not likely at all to 5 = very
likely) for strengthening and
stretching exercises. 9-point Likert
scale (0 = 0 days to 7 = 7 days) for
other physical activity questions
(CDC, 2017). 5PA attitudes by
perceived positive or negative
effects of being physically active
(e.g., PA is useful/useless, healthy/
unhealthy, and good/bad)
6Affective attitude as indicated by
the enjoyment level of doing PA
(e.g., PA is enjoyable/unenjoyable,
interesting/boring, and pleasant/
unpleasant). A 7-point Likert scale
was used to assess attitudes,
where a score of 1 indicated a
positive attitude, and a score of
7 indicated a negative attitude.
(Ajzen 1991)]. PA = physical
activity, 7SD = standard deviation.
INTENTION AND ACTUAL PA MEAN (SD)7MEDIAN
Intention13.58 (1.37) (Min. = 1, Max. = 5) 4
General23.86 (2.48) (Min. = 0, Max. = 8) 3
Strengthening32.95 (2.14) (Min. = 0, Max. = 8) 3
Stretching43.02 (2.11) (Min. = 0, Max. = 8) 3
Attitude toward PA (Min. = 1, Max. = 7)
Useful/useless 2.03 (1.82) 1
Healthy/unhealthy 1.74 (1.67) 1
Good/bad 1.58 (1.52) 1
Enjoyable/unenjoyable 2.47 (1.94) 2
Interesting/boring 2.51 (1.94) 2
Pleasant/unpleasant 2.46 (1.94) 2
Attitude toward advantages/disadvantages of PA55.31 (4.47) 3
Attitude toward enjoyment of PA67.43 (5.35) 7
Total score of attitudes toward PA 12.75 (9.01) 11

Table 4 Aging anxiety and
different sociodemographic
characteristics of African
American middle age and
older adults.
Note: 1Interquartile range.
2Standard deviation 3Never
married, widowed, divorced,
and separated. Bolded
p-values indicate a significant
relationship. 5-point Likert
scale (strongly disagree to
strongly agree) measuring
aging anxiety, with higher
scores indicating higher
anxiety levels (Lasher and
Faulkender 1993).
CHARACTERISTICS AGING ANXIETY CONSTRUCTS
FEAR OF
OLDER
ADULTS
PSYCHOLO-
GICAL
CONCERNS
PHYSICAL
APPEARANCE
FEAR OF
LOSS
TOTAL SCORE
OF AGING
ANXIETY
MEAN (SD) MEAN (SD) MEAN (SD) MEAN (SD) MEAN (SD)
MEDIAN
(IQR)1
MEDIAN
(IQR)1
MEDIAN
(IQR)1
MEDIAN
(IQR)1
MEDIAN
(IQR)1
Gender
Female 19.02 (3.09) 17.88 (2.17) 17.05 (2.82) 10.67 (3.98) 64.67 (7.45)
19 (16–21) 18 (16–19) 17 (15–19) 11 (8–13) 64 (60–69)
Male 19.31 (3.49) 18.84 (2.82) 17.68 (3.50) 11.26 (3.90) 67. 03 (8.43)
20 (16–21) 19 (18–21) 18 (15–20) 11 (9–14) 67 (61–74)
p-Value 0.4071 0.0063 0.3160 0.0289 0.0334
Age (years)
40–49 19.53 (3.25) 18.60 (3.10) 16.41 (3.58) 9.8 (4.52) 64.25 (8.46)
19 (18–21) 18 (17–20) 16 (14–17) 9.5 (6–14) 64 (58.5–71)
50–59 19.76 (3.68) 17.95 (2.64) 16.40 (2.98) 10.78 (3.89) 64.90 (8.64)
20 (17–23) 19 (16–20) 16 (14–19) 11 (8–13) 64.5 (58–71)
60–69 18.84 (3.05) 18.32 (2.45) 18.06 (3.31) 11.44 (3.77) 66.67 (7.72)
19 (16–21) 18 (17–20) 19 (15–20) 11 (10–14) 66 (61–73)
70+ 18.63 (2.94) 17.91 (2.24) 17.63 (2.13) 11.10 (3.77) 65.28 (6.92)
19 (16–20) 18 (17–19) 18 (16–19) 11 (10–13) 65 (60–70)
p-Value 0.3065 0.8260 0.0133 0.4597 0.5153
Education
High school or less 19.06 (3.55) 17.84 (3.02) 17.17 (3.61) 10.74 (3.12) 64.71 (7.67)
19 (16–21) 19 (15–20) 17 (14–19) 11 (8–13) 65 (58–70)
More than high school 19.11 (3.12) 18.26 (2.37) 17.30 (2.87) 10.98 (4.19) 65.70 (7.96)
19 (16–21) 18 (17–20) 17 (15–19) 11 (8.13) 65 (60–72)
p-Value 0.8757 0.9284 0.8522 0.6683 0.5629
Marital status
Single319.18 (3.28) 18.05 (2.62) 17.15 (2.97) 10.59 (3.88) 64.97 (7.89)
19 (16.5–21) 18 (16–20) 17 (15–19) 11 (8–13) 65 (59–71)
Married 18.93 (3.13) 18.34 (2.42) 17.51 (3.29) 11.60 (3.97) 66.39 (7.81)
19 (16–21) 18.5 (17–20) 17 (15–20) 12 (10–14) 66.5 (60–72)
p-Value 0.5753 0.7573 0.6049 0.0472 0.2659
Location of residence
City 18.98 (3.26) 18.20 (2.84) 17.33 (3.11) 10.55 (3.86) 65.02 (7.52)
19 (16–21) 19 (17–20) 18 (15–19) 11 (8–13) 0265 (60–71)
Non-city 19.21 (3.21) 18.10 (2.24) 17.20 (3.05) 11.29 (3.98) 65.87 (8.24)
19.5 (16–21) 18 (17–20) 17 (15–19.5) 11 (9–13) 65 (60–72)
p-Value 0.5954 0.5191 0.7707 0.3112 0.7018
Income (USD)
≤20,000 18.92 (3.25) 17.80 (2.83) 16.92 (3.26) 9.78 (4.01) 63.33 (7.83)
19 (17–21) 18 (15–20) 17 (14–19) 10 (6–13) 63 (57–68)
20,001–30,000 19.40 (3.38) 18.51 (2.94) 17.96 (3.61) 10.23 (3.32) 66.27 (7.81)
19 (17–22) 19 (17–21) 18.5(15–20) 10.5 (9–12) 66 (61–73)
30,001–50,000 19.03 (3.18) 18.46 (2.40) 17.56 (3.21) 11.76 (4.52) 66.83 (8.43)
19 (16–21) 19 (17–20) 18 (16–19) 11 (10–14) 66 (62–72)
>50,000 19.22 (3.27) 18.20 (2.19) 17.15 (2.48) 11.89 (3.59) 66.48 (7.59)
19.5 (16–21) 18 (17–20) 17 (15–19) 12 (10–14) 65 (61–71)
p-Value 0.9056 0.5531 0.4098 0.0140 0.0875

There was a significant negative relationship between positive attitudes towards physical
activity, including useful, healthy, good, enjoyable, interesting, and pleasant attitudes, and
the fear of older adults. Participants who held positive attitudes towards physical activity had
less fear of older adults. In addition, all PA attitudes, except useful/useless attitudes, were
negatively related to possessing psychological concerns, which means that a positive attitude
results in less concern about psychology. Three positive attitudes, namely, healthy, enjoyable,
and pleasant, were related to fear of loss. However, no relationship between PA attitude and
physical appearance in this set of analyses was detected. Finally, all the PA attitudes were
significantly related to total aging anxiety (Table 6).
Table 5 Aging anxiety, aging
anxiety constructs, and PA.
Note: 1I intend to perform PA
for 30 min/day for at least 3
days/week over the next 2
months (future). 2During the
past seven days, how many
days did you walk for at
least 10 min at a time for fun,
relaxation, exercise, or to walk
the dog? 3How many times
per week do you do physical
activities specifically designed
to strengthen your muscles,
such as lifting weights or doing
calisthenics (e.g., exercising
large muscle groups)? 4How
many times per week do you
do physical activities designed
to stretch your muscles, such as
yoga or exercises like bending
side-to-side, toe-touching, and
leg stretches? 5-point Likert
scale (1 = not likely at all to 5 =
very likely) for strengthening
and stretching exercises. 9-point
Likert scale (0 = 0 days to 7 = 7
days) for other physical activity
questions (CDC, 2017). 5-point
Likert scale (strongly disagree
to strongly agree) measuring
aging anxiety, with higher
scores indicating higher anxiety
levels (Lasher and Faulkender
1993).Bolded p-values indicate
a significant relationship.
FEAR OF
OLDER
ADULTS
PSYCHOLO-
GICAL
CONCERNS
PHYSICAL
APPEARANCE
FEAR
OF LOSS
TOTAL SCORE
OF AGING
ANXIETY
Intention1
Correlation coefficient 0.2160 0.0925 0.0210 0.0266 0.1523
p-Value 0.0038 0.2220 0.7806 0.7241 0.0435
General2
Correlation coefficient −0.0732 0.0469 0.0221 −0.0330 0.1549
p-Value 0.3316 0.5358 0.7694 0.6614 0.0401
Strengthening3
Correlation coefficient −0.03395 −0.0290 −0.1870 −0.0740 −0.0679
p-Value 0.6529 0.7015 0.0126 0.3262 0.3703
Stretching4
Correlation coefficient 0.0672 −0.0155 −0.0743 0.0221 0.0804
p-Value 0.3723 0.8382 0.3252 0.7692 0.2886
Table 6 Aging anxiety and
attitudes toward PA.
Note: 1PA attitudes via the
perceived positive or negative
effects of being physically
active (e.g., PA is useful/
useless, healthy/unhealthy,
and good/bad). 2Affective
attitude as indicated by
the enjoyment level of
participating in PA (e.g., PA
is enjoyable/unenjoyable,
interesting/boring, and
pleasant/unpleasant). A
7-point Likert scale was used
to assess attitudes, where a
score of 1 indicated a positive
attitude, and a score of 7
indicated a negative attitude.
(Ajzen 1991). 3Physical activity.
5-point Likert scale (strongly
disagree to strongly agree)
measuring aging anxiety, with
higher scores indicating higher
anxiety levels (Lasher and
Faulkender 1993).
Bolded p-values indicate a
significant relationship.
FEAR OF
OLDER
ADULTS
PSYCHOLO-
GICAL
CONCERNS
PHYSICAL
APPEAR-
ANCE
FEAR OF
LOSSES
TOTAL SCORE
OF AGING
ANXIETY
Useful/useless
Correlation coefficient −0.1972 −0.0451 −0.0409 −0.1008 −0.1802
p-Value 0.0085 0.5533 0.5893 0.1815 0.0170
Healthy/unhealthy
Correlation coefficient −0.2685 −0.1761 −0.0953 −0.1780 −0.2877
p-Value 0.0003 0.0208 0.2121 0.0187 0.0001
Good/bad
Correlation coefficient −0.2070 −0.1541 −0.0500 −0.0992 −0.2180
p-Value 0.0057 0.0416 0.5098 0.1886 0.0037
Enjoyable/unenjoyable
Correlation coefficient −0.3418 −0.2577 −0.1064 −0.1731 −0.3731
p-Value <0.0001 0.0006 0.1585 0.0208 <0.0001
Interesting/boring
Correlation coefficient −0.3388 −0.17129 −0.1149 −0.1049 −0.3060
p-Value <0.0001 0.0234 0.1289 0.1643 <0.0001
Pleasant/unpleasant
Correlation coefficient −0.2730 −0.2125 −0.1010 −0.1803 −0.3277
p-Value 0.0002 0.0046 0.1725 0.0160 <0.0001
Attitude toward PA advantage/
disadvantage1
Correlation coefficient −0.23011 −0.1092 −0.0618 −0.12482 −0.22623
p-Value 0.0020 0.1489 0.4136 0.0969 0.0025
Attitude toward PA enjoyment2
Correlation coefficient −0.3312 −0.2220 −0.1235 −0.1624 −0.3572
p-Value <0.0001 0.0031 0.1014 0.0303 <0.0001
Total score attitude toward PA
Correlation coefficient −0.3221 −0.2166 −0.1038 −0.1665 −0.3438
p-Value <0.0001 0.0039 0.1690 0.0263 <0.0001

288Monroe-Lord et al.
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DOI: 10.5334/paah.287
Perceiving PA as a tool that has more advantages for individuals was significantly related to a
lower fear of older adults and generally a lower score of aging anxiety. In addition, perceiving
PA as a tool for enjoyment was related to all the aging anxiety constructs and the total score of
aging anxiety, except physical appearance (Table 6).
The results from Table 7 revealed that gender and perceiving PA as enjoyable were significant
independent predictors of the fear of older adults. Females were approximately two times more
likely to fear older adults than male participants (p = 0.0406). In addition, for each one-point
increase in the score of the enjoyment PA attitude, the participants were 1.1 times more likely
to be less afraid of older adults and have psychological concerns (p = 0.003 and p = 0.0306,
respectively). Among the different age groups, participants aged 40–49 years were 3.7 and 3.3
times more likely to be anxious about their appearance when compared to participants aged
60–69 years and above 70 years (p = 0.0118 and p = 0.0408, respectively). In addition, the
participants aged 50–59 years were 2.4 times more likely to be anxious about their appearance
in comparison to their counterparts aged 60–69 years (p = 0.0428).
Another predictor of physical appearance concerns was participating in strengthening activities.
For each one-point increase in the score of strengthening activity, the participants were 1.2 times
more likely to be less concerned about their physical appearance (p = 0.0237). Furthermore,
marital status and income level were independent predictors of fear of loss. Those participants
who were married were 57% less likely to fear loss (p = 0.0246). With respect to the different
income group levels, those participants with less than $20,000 per year were 3.5 and 2.3 times
more likely to fear a loss in comparison to participants who earned between $30,001 and $50,000
and those who earned more than $50,000 per year (p = 0.0124 and p = 0.0441, respectively).
Table 7 Association between
aging anxiety and its
constructs, as well as the
association between PA and
attitudes toward PA, while
controlling for different
demographic variables.
Note: 5-point Likert scale (1
= not likely at all to 5 = very
likely) for strengthening and
stretching exercises. 9-point
Likert scale (0 = 0 days to 7
= 7 days) for other physical
activity questions (CDC, 2017).
A 7-point Likert scale was used
to assess attitudes, where a
score of 1 indicated a positive
attitude, and a score of 7
indicated a negative attitude
(Ajzen 1991). 1Confidence
interval, 2physical activity.
Bolded p-values indicate
the significant relationship.
5-point Likert scale (strongly
disagree to strongly agree)
measuring aging anxiety, with
higher scores indicating higher
anxiety levels (Lasher and
Faulkender 1993).
REFERENCE ODDS
RATIO
95% CI1
P
-VALUE
Fear of older adults
Gender Female 1.993 1.03–3.85 0.0406
Attitude toward PA2 enjoyment 1.121 1.05–1.19 0.0003
Psychological concerns
Attitude toward PA enjoyment 1.066 1.01–1.12 0.0306
Physical appearance
Age (years) 40–49 vs. 50–59 1.568 0.53–4.63 0.4153
40–49 vs. 60–69 3.737 1.34–10.42 0.0118
40–49 vs. ≥70 3.301 1.04–8.76 0.0408
50–59 vs. 60–69 2.383 1.02–5.52 0.0428
50–59 vs. ≥70 1.932 0.79–4.68 0.1444
60–69 vs. ≥70 0.811 0.36–1.81 0.6099
Strengthening 1.201 1.02–1.40 0.0237
Fear of loss
Marital status Married 0.434 0.20–0.90 0.0264
Income (USD) ≤20,000 vs. 20,001–30,000 1.418 0.57–3.51 0.4502
≤20,000 vs. 30,001–50,000 3.501 1.31–9.34 0.0124
≤20,000 vs. >50,000 2.276 1.02–5.06 0.0441
20,001–30,000 vs. 30,001–50,000 2.469 0.82–7.37 0.1055
20,001–30,000 vs. >50,000 1.605 0.62–4.15 0.3299
30,001vs. >50,000 0.650 0.23–1.78 0.4042
Total score of aging anxiety
Gender Female 2.354 1.19–4.63 0.0013
Attitude toward PA enjoyment 1.136 1.06–1.21 <0.0001

289Monroe-Lord et al.
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DOI: 10.5334/paah.287
In the last part of the analysis, gender and enjoyment PA attitudes were identified as independent
predictors of aging anxiety (p = 0.0013 and p < 0.0001, respectively). Female participants were
2.3 times more likely to experience aging anxiety than their male counterparts, whereas, for
each one-point increase in the score of enjoyment PA attitudes, participants were 1.1 times less
likely to have aging anxiety.
4. DISCUSSION
The current study evaluated how different sociodemographic variables in the context of
participating in PA and attitudes toward PA are related to aging anxiety and its constructs. To the
best of our knowledge, this is the first study that has collected data on all these factors together
to assess aging anxiety and its one-by-one constructs among African Americans. The findings
of this study revealed which individual sociodemographic and PA factors may be associated
with lower anxiety about aging among this minority population. Our results indicated that the
highest anxiety regarding aging was fear of loss, while the lowest was fear of older adults.
Overall, participants had a positive attitude toward the advantages and enjoyment of PA.
Among the different sociodemographic factors, gender, age, income, and marital status were
found to be associated with aging anxiety and its constructs. Previous research on aging anxiety
has shown that it relates to age and gender. These studies were on Hispanic and Taiwanese
populations and showed that younger people have higher levels of aging anxiety than older
adults (Fernández-Jiménez et al. 2020; Yu-Jing 2012). In our study, females were about 2 times
more afraid of older adults and in general, were approximately 2.3 times more anxious about
aging than their male counterparts. Research findings also revealed that males and females
experience aging and anxiety differently based on their current life period (Lynch 2016). The
results showed that the younger participants were more anxious about their physical appearance.
The trend of this construct of aging anxiety decreased with aging, which means that participants
aged 40–49 years old were more anxious about their appearance in comparison to the same
group aged 50–59 years. In addition, married participants were less afraid of losses than single
participants. A previous study did show that an older person living alone suffers from more
anxiety (Yu, Choe and Kang 2020). Singles who usually live alone may imagine themselves in
the same situation in the future and thus may experience more fear of loss regarding everything
they have in their lives. Furthermore, the lower-income participants possessed a higher level of
fear of loss than higher income participants. Individuals with a higher income level perceive their
belongings as safer than those of someone with a lower income level.
Among the four types of physical activity, strengthening exercises were significantly associated
with the physical appearance construct of aging anxiety in both the univariate and multivariate
analyses. Increasing the number of strengthening exercises was associated with lower anxiety
regarding physical changes in appearance. Strength training conserves bone mass and muscle,
reduces sarcopenia, prevents dementia and retains motor function in older adults (Marinus et
al. 2019; Müller et al. 2018). Another study also showed that heavy-load strength training is a
multifaceted intervention that spans both health and disease spectrums, offering a promising
approach to enhance physical fitness, mitigate illness symptoms, and ultimately improve the
overall quality of life for individuals across various health conditions (Cannataro et al. 2022;
Malorgio et al. 2021). These reasons could provide a rationale for the lower fear of physical
appearance in our participants. Moreover, possessing an enjoyable attitude toward PA predicted
a reduction in two constructs out of four in respect of aging anxiety, including fear of older
adults and psychological concerns, as well as aging anxiety. This means that positive attitudes
toward PA may result in lower anxiety with respect to aging among African American middle-
aged and older adults. Meanwhile, perceiving PA from the advantage/disadvantage perspective
was not associated with lower aging anxiety or its constructs.
A limitation of this study is that it consisted of a convenience and small sample size and,
therefore, the findings are not generalizable. Additionally, as the study design was cross-
sectional, we could only determine associations between variables, not causality. A larger
study may provide more evidence on the association between PA and aging anxiety and may
be a basis for interventions that could improve the mental and physical health of individuals.
The primary strength of this study is its focus on African Americans. Limited data is available on
this population group and especially on this age groups, Future studies of minority populations
could contribute to finding strategies to prevent aging anxiety based on race and culture.

290Monroe-Lord et al.
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5. CONCLUSIONS
The results showed aging anxiety and fear of older adults differed significantly by gender.
African American females are more anxious than males regarding aging. Perceiving PA as
an enjoyable activity also resulted in less fear of older adults, fewer psychological concerns,
and less aging anxiety. Younger African Americans were more worried about their physical
appearance than older individuals, and strengthening exercises were identified as an effective
way to control this concern of aging anxiety. Furthermore, the results of the study indicated
that fear of loss was the most anxiety-inducing factor among the participants. Fear of loss was
also associated with marital status and income level. Utilizing the findings of this study can
help to develop educational workshops to control aging anxiety while discussing the health
benefits of PA participation.
DATA ACCESSIBILITY STATEMENTS
The data presented in this study are available on request from the corresponding author. The
data are not publicly available due to measures to protect participant confidentiality.
ETHICS AND CONSENT
The Iowa State University Institutional Review Board approved this study protocol on September
16, 2020, which was deemed exempt with the ID 20–384.
Informed consent was obtained from all subjects involved in the study.
FUNDING INFORMATION
This research was funded by the USDA NE-1939 Multistate Project “Improving the health span
of aging adults through diet and physical activity” grant number 1021991; supported by the
Lura M. Lovell Fellowship; funded by the USDA/NIFA Hatch Project grant number 1011487;
funded by the University of the District of Columbia Multistate Project, West Virginia Agricultural
and Forestry Experiment Station, National Institute of Food and Agriculture, U.S. Department of
Agriculture, Hatch/Multi-State grant number 1021322.
COMPETING INTERESTS
The authors have no competing interests to declare.
AUTHOR CONTRIBUTIONS
Conceptualization, L.M.-L., A.A., L.W. and S.L.F.; methodology, L.M.-L., E.H., A.A., S.L.F., F.X.,
M.V.M., L.W., and N.R.S. formal analysis, L.M.-L., A.A., E.H. investigation, L.M.-L., A.A., E.H., writing
the first draft of the manuscript, L.M.-L., A.A., review and editing, L.M.-L., A.A., E.H., S.L.F., F.X.,
M.V.M., L.W., and N.R.S. All authors have read and agreed to the published version of the
manuscript.
AUTHOR AFFILIATIONS
Lillie Monroe-Lord orcid.org/0000-0003-1131-9626
College of Agriculture, Urban Sustainability, and Environmental Sciences, University of the District of
Columbia, Washington, DC 20008, USA
Elgloria Harrison orcid.org/0000-0003-2627-9524
Lehman College City University of New York, West, Bronx, NY 10468, USA
Azam Ardakani orcid.org/0000-0003-3863-6111
College of Agriculture, Urban Sustainability, and Environmental Sciences, University of the District of
Columbia, Washington, DC 20008, USA
Sarah L. Francis orcid.org/0000-0001-7761-5220
Department of Food Science and Human Nutrition, Iowa State University, Ames, IA 50011, USA
Furong Xu orcid.org/0000-0002-4377-6461
School of Education, University of Rhode Island, Kingston, RI 02881, USA

291Monroe-Lord et al.
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Melissa Ventura Marra orcid.org/0000-0002-5227-3313
School of Agriculture and Foods, West Virginia University, Morgantown, WV 26506, USA
Lee Weidauer orcid.org/0000-0001-7058-330X
School of Health and Consumer Sciences, South Dakota State University, Brookings, SD 57007, USA
Anna E. Arthur orcid.org/0000-0002-5208-4336
Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
Nadine R. Sahyoun orcid.org/0000-0003-2309-1868
Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA
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TO CITE THIS ARTICLE:
Monroe-Lord, L., Harrison, E.,
Ardakani, A., Francis, S. L., Xu,
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Submitted: 15 June 2023
Accepted: 03 September 2023
Published: 02 October 2023
COPYRIGHT:
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Physical Activity and Health is
a peer-reviewed open access
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