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Physical activity participation among older adults with diabetes: Applying the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) Guidelines

Published online by Cambridge University Press:  18 November 2021

Chenchen Yang
Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
Elias Mpofu
Rehabilitation and Health Services, University of North Texas, Denton, TX, USA School of Health Sciences, University of Sydney, Sydney, Australia Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
Xiaoli Li*
Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
Diana Dorstyn
School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Qiwei Li
School of Nursing, John Hopkins University, Baltimore, MD, USA
Kaye Brock
School of Medical Sciences, University of Sydney, Sydney, Australia
*Corresponding author: Email:
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Physical activity (PA) is a known benefit to older adults with diabetes; however, the determinants of PA are less well studied in this population. Applying the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a well-established biopsychosocial framework, we explored PA participation among older adult with type 2 diabetes.


Using data from the Health and Retirement Study and the RAND Center for the Study of Aging (N = 2,016; mean age = 73.19; SD = 6.16), we conducted hierarchical stepwise regression analysis to evaluate the relative contribution of different biopsychosocial predictors to PA – namely, body functions and structure, activity and participation, personal, and environmental factors.


Altogether, biopsychosocial factors accounted for 20% of the variance in PA participation. Of the personal factors, high extraversion and low neuroticism explained approximately 54% of the variance in PA among the older adults – beyond sociodemographics. Low body mass index, reduced pain, reduced depression, and higher cognitive functioning also had good explanatory power (25% of explained variance), whereas activity participation and environment did not (10% each).


Aligning care with components of the ICF will help to ensure a focus on person-centric practices and, in turn, optimize participation outcomes such as PA.

© The Author(s), 2021. Published by Cambridge University Press and The Australian Journal of Rehabilitation Counselling

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