1. Effects of physical exercise programme on happiness
among older people
M . K H A Z A E E - P O O L 1
P h D , R . S A D E G H I 2
P h D , F. M A J L E S S I 3
M D & M P H i n M C H
& A . R A H I M I F O R O U S H A N I 4
P h D
1
PhD Candidate, 2
Assistant Professor, 3
Professor, Department of Health Education and Promotion, and
4
Associated Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University
of Medical Sciences, Tehran, Iran
Keywords: exercise programme,
happiness, Iran, older
Correspondence:
M. Khazaeepool
Department of Health Education and
Promotion
School of Public Health
Tehran University of Medical Sciences
Tehran 0098-46511-84866
Iran
E-mail: khazaie_m@yahoo.com
Accepted for publication: 22 June 2014
doi: 10.1111/jpm.12168
Accessible summary
• This randomized-controlled trial investigated the effect of physical exercise pro-
gramme (PEP) on happiness among older adults in Nowshahr, Iran.
• Results of this study on 120 male and female volunteers showed that an 8-week
group physical exercise programme was significantly effective in older adults’
happiness.
• Findings showed that physical exercise programme is so beneficial for increasing
older adults’ happiness.
Abstract
Physical activity is associated with well-being and happiness. The purpose of this
study was to determine the effects of an 8-week long physical exercise programme
(PEP) on happiness among older adults in Nowshahr, Iran. This was a randomized
control trial study. The participants consisted of a group of 120 male and female
volunteers (mean ± SD age: 71 ± 5.86 years) in a convenience sampling among
older adults in public parks in Nowshahr, Iran. We randomly allocated them into
experimental (n = 60) and control (n = 60) groups. A validated instrument was
used to measure well-being and happiness [Oxford Happiness Inventory (OHI)].
Respondents were asked to complete the OHI before and 2 months after imple-
menting PEP. The 8-week PEP was implemented with the intervention group. The
statistical analysis of the data was conducted using paired t-test, Fisher’s exact test
and χ2
. Before the intervention, there was no significant difference in the happiness
mean score between the case and control groups; however, after implementing
PEP, happiness significantly improved among the experimental group (P = 0.001)
and did not improve within the control group (P = 0.79). It can be concluded that
PEP had positive effects on happiness among older adults. Planning and imple-
menting of physical activity is so important for older happiness.
Introduction
Ageing is a complex process of physical, psychological and
social changes. Older people are among the most vulner-
able groups to health-care quality problems, and they have
particular needs. Ageing is an unavoidable and irreversible
phenomenon (Ferhan & Vesile 2011) but can be experi-
enced in a manner deemed successful. Successful ageing
encompasses multiple dimensions of health, including
physical, functional, social and psychological well-being
(Phelan et al. 2004). The numbers of older people in the
total population is currently increasing throughout the
world (Ferhan & Vesile 2011). This increase in the older
population is more attributable to advances in public
Journal of Psychiatric and Mental Health Nursing, 2015, 22, 47–57
© 2014 John Wiley & Sons Ltd 47

2. health and the social determinants than to medical care
(Taleb et al. 2009). Since 2000, the proportion of older
adults in the world has increased from 10.0% to 14.2%
by 2009, and it will increase to 21.0% in 2025–2050
(Population Division, Department of Economic and Social
Affairs 2009).
The number of older adults in Iran is 5 600 000,
which constitutes 5.7% of Iran’s population in year 2012,
but it will rise by approximately 21% by 2050 ( SCI
2011). Based on the last Iranian census in 2011, a life
expectancy of 74.6 and 72.1 has been registered for
Iranian women and men, respectively (Islamic Republic
News Agency 2012). As the World Health Organization
(WHO) indicates, this increase in the number of older
adults has led to the need for health-care system reform
to integrate elder health services into routine health ser-
vices (WHO 2001). The advancing age of the population
has produced an increased need to identify factors that
contribute to the ability of the older adults to maintain
their activity and independent lifestyle, specifically to
identify factors that may delay or prevent frailty and dis-
ability (Abellan van Kan et al. 2009).
Ageing is associated with many social and psychologi-
cal changes that may lead to disease and disability, and
reduce the level of happiness in older adults. Happiness
is improving significant component of mental health for
older adults (Angner et al. 2009). Internal and external
factors influencing life happiness are self-esteem, satisfac-
tion with self performance, adequate income and living
in a healthy family (Argyle & Martin 1991). Happiness
has been defined as ‘a lasting, complete, and justified sat-
isfaction with life as a whole’ (Tatarkiewicz 1979). Also,
happiness has been conceptualized as a positive inner
experience, the highest good and the ultimate motivator
for all human behaviours (Lu et al. 2001). Happiness
is a multidimensional construct comprising both emo-
tional and cognitive elements (Argyle & Crossland
1987).
The three main components of happiness that have been
identified by researchers are frequent positive affection or
joy, high level of life satisfaction over a period of time, and
the absence of negative feelings such as depression and
anxiety (Argyle & Crossland 1987). One of the key strat-
egies for improving happiness and reducing negative feeling
is physical activity, which contributes to healthy ageing by
preventing disability, morbidity and mortality in older
adults (Christ & Ross 2010, Fararouei et al. 2013). Despite
its many benefits, physical activity participation declines
progressively with age (United States Department of Health
and Human Services 2006). People living with limitations
to physical activity might have fewer opportunities to be
satisfied with life or experience happiness, which can have
a negative effect on their overall quality of life (QOL)
(Newall et al. 2013). In line with this tenet, research has
shown that the more that older adults engage in social,
physical and cognitive activities, the happier they are (Inal
et al. 2007). The health benefits of physical activity for
older adults are well documented in terms of reduced mor-
tality (Chakravarty et al. 2008), better functional, physical
and more positive affect (Netz et al. 2007), and less cogni-
tive decline (Klusmann et al. 2010).
Studies have shown that physical activity has a positive
effect on happiness, mental health, self-efficacy, self-esteem,
life satisfaction and positive mood (Hills & Argyle 1998,
Allison & Keller 2004, Spence et al. 2005, McNeill et al.
2006, Denny & Steiner 2009, Martin et al. 2009).
Within this context, self-esteem and self-efficacy have been
regarded as an important element of well-being and are
constructs that might be amenable to change through exer-
cise. Self-esteem is defined as the experience of being able to
deal with life’s problems and the appraisal of being worthy
of happiness (Acil et al. 2008). Physical exercise largely
increases a person’s self-esteem and mental health while
reducing stress (Spence et al. 2005, Acil et al. 2008). Self-
efficacy is defined as one’s confidence in his/her own ability
to promote suitable solutions and perfect duties necessary
to be successful in various efforts (Allison & Keller 2004,
McNeill et al. 2006). Also, studies show that regular physi-
cal activity can improve mental health, increase social
interaction and decrease social isolation among people
with serious mental illness (Faulkner & Sparkes 1999,
Carter-Morris & Faulkner 2003, Chodzko-Zajko et al.
2009).
Despite these positive effects, controlled studies on
older adults and happiness in the context of physical
activity are limited, and many older adults are not suffi-
ciently active to enjoy these health benefits (Schoenborn
et al. 2006). Hence, recognizing strategies to enhance
physical activity in this large and growing segment of the
population is a public health priority ( Task Force on
Community Preventive Services 2002). The level of physi-
cal activity is too low among Iranians, specifically older
adults, as evidenced by survey of risk factors for non-
communicable diseases in Iran that found that about
60.6% of older men and 77% of older women were inac-
tive because of smoking, air pollution, busy life, lack of
time and low literacy (Alikhani 2005). Other study in
Yazd, centre of Iran, showed that the rate of physical
inactivity among adult was approximately 65.8%, and
women (81.6%) were more active than men (54.4%)
(Motefaker et al. 2007), and Iranian older adults, espe-
cially women, are at risk for sedentary behaviour due to
specific cultural barriers, such as exercise limitations in
public places (Taymoori et al. 2010).
M. Khazaee-pool et al.
48 © 2014 John Wiley & Sons Ltd

3. Although it is clear that there is a statistical relationship
between physical activity and happiness, limited research
has delved into the issue of cause and effect. There is a lack
of information regarding the association between physical
exercise and happiness in older adults. In particular, the
casual nature of this relationship remains unclear. It can be
hypothesized that correlations can exist due to the effect of
physical activity on happiness rather than by the effects of
happiness on physical activity. To disentangle cause and
effect, we need controlled trials. Therefore, this study was
designed to examine physical exercises programme and its
impact on happiness of older adults. In considering the
influences of physical activity, it was hypothesized that it
would be positively related to happiness.
Subjects and method
Designed to investigate the effects of an 8-week physical
exercise programme (PEP) on happiness among older
adults, this study was conducted using a randomized
control trial methodology. A total of 120 male and female
volunteers ranging from 65 to 89 years were randomly
allocated to subgroups ‘experimental (n = 60) and control
(n = 60) groups’ over 2 months, from April to June 2011.
Blinding of allocation was assured by the separation of the
randomization process from researchers involved in the
assessment. To ensure that each group was uniformly rep-
resented over the time course of the study, a varying-block
randomization protocol was used: varying block sizes of
four and six were used to ensure that randomization out-
comes could not be predicted. Each new participant was
assigned to the next consecutive number. All members who
were involved in the project (investigators, outcome asses-
sors, and participants) were blinded to this study. Prior
to investigation, each participant completed a written
informed consent. The study was conducted with the
approval of the institutional review mayoralty at the
Nowshahr province of Iran. No external funding was
provided for this project. Due to the low level of physical
activity among Iranian older adults, researchers used a
convenience sampling among older adults who were avail-
able in public parks in Nowshahr, Iran.
Sample size was determined based on the estimation of
happiness proportion in older adults. Based on previous
study in Iran, 60% of older adults had lower happiness
(Salesi & Jowkar 2011). In this study also, the proportion of
older adults with lower happiness was equal to 60%, and
people who had good happiness were 40%. It was assumed
that if happiness score increases at least 20% after the
exercise programme, it would be statistically significant.
Therefore, the sample size in each group was 47 older adults,
with 95% confidence interval and the power of a hypothesis
test was 80%. About 30% more samples to reduce the
possible loss of the samples was considered. In total, it was
used 120 older adults for sample size.
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Inclusion and exclusion criteria
Inclusion criteria were men or women of at least 65 years
of age; have no medical contraindication for physical activ-
ity, such as stroke, Parkinson’s disease, cardiovascular dis-
orders, acute heart failure, uncontrolled hypertension and
diabetes; and have the ability to perform routine daily tasks
without dependence on others. Participants with a history
of overt cardiovascular disease, stroke and congestive
heart failure, and lower extremity revascularization were
excluded because of the possible confounding influences
that cardiovascular disease may have on physical activity.
A final exclusion criterion was severe anxiety. Based on
the multidimensional anxiety theory (Martens et al. 1990),
severe anxiety can significantly reduce athletic perfor-
mance. Therefore, according to the target group in this
study, people with severe anxiety were excluded as they
might not be able to exercise properly according to the
designed programme.
Measures
In order to collect data, a two-section instrument was used,
including a demographic data form (consisting of questions
related to age, gender, level of education, marital status,
occupation, and level of physical activity in the past and the
present) and the Oxford Happiness Inventory (OHI). The
OHI is a broad measure of personal happiness that was
designed by the Department of Experimental Psychology of
the University of Oxford in the late 1980s (Argyle et al.
1989). The OHI follows the design and format of the Beck
Depression Inventory (BDI) (Argyle et al. 1989). We used
the Persian/Farsi version of the OHI in this project. Alipoor
& Noorbala (1999) translated the inventory into Farsi
and adapted it to Iranian culture (Alipoor & Noorbala
1999). The instrument consists of 29 items in five domains,
namely satisfaction (eleven items), positive mood (eight
items), mental health (six items), efficiency (four items) and
self-esteem (two items). Each item is presented in four
incremental levels, namely (1) strongly disagree, (2) fairly
disagree, (3) fairly agree and (4) strongly agree. The score
Physical exercise programme and happiness
© 2014 John Wiley & Sons Ltd 49

4. range is between zero and three (the maximum score = 87,
with a minimum of 0). The internal consistency coefficient
of the Iranian format of the OHI was 0.98. To determine
the validity of the instrument, content validity has been
utilized and confirmed (0.92) (Alipoor & Noorbala 1999,
Alipour & Agah Heris 2007). Validity has also been
evaluated by a number of researchers and instructors of
subject matter at the Isfahan University of Medical
Sciences, and by some psychology experts in Isfahan
University (Liaghatdar et al. 2008). In a pilot study, 20
questionnaires were distributed among older adults in the
study area. Data analysis was conducted and Cronbach’s
alpha coefficients were r = 0.95, r = 0.91 and r = 0.87 for
the first, second and third week, respectively. The question-
naires were completed by all respondents, and the data
were analysed using the SPSS software version 14 (IBM
Company, New York, United States). Based on the results
of this analysis, a physical activity programme was
designed and implemented on the experimental group.
Participants in the intervention group were followed for
8 weeks of their training programme supervised by physical
education expert. The PEP used in this study was based on
a training package that was prepared for older adults by
the Health Ministry of Iran. The place of exercise pro-
gramme was separated for two groups. The intervention
group participated in the designed activity programme, but
the control group just did their regular activities. The PEP
occurred three times a week, in the morning at 10:30 in
a public park. After implementing the educational pro-
gramme for 8 weeks, the questionnaire was again com-
pleted by both the experimental and control groups. The
PEP was divided into three consecutive parts, as shown in
Table 1.
Statistical analysis
The statistical tests included paired t-test, Fisher’s exact test
and χ2
.
Results
A total of 120 older adults participated in this study. The
mean age of the respondents was 71 years (SD = 5.86), the
majority of them (43%) ranging from 65 to 89 years. More
than half (69.2%) of the participants were males, 86.65%
were married, and 83.35% had less than a diploma educa-
tion. Nearly 82.5% of the participants were being finan-
cially supported by their spouse and/or children. The
majority (80.85%) of individuals had an income under
$500 per month. The majority (76.7%) of participants had
health insurance. As shown in Table 2, there was no sig-
nificant difference between the experimental and control
groups in terms of marital status, education, social support
sources, work status, leisure time physical activity and
health insurance.
The results of this study showed a significant inverse
relationship between age and the level of happiness before
the exercise programme, while such a relationship was not
observed after the exercise programme in the intervention
group. Across the whole sample, before the exercise pro-
gramme, those with higher subjective happiness were more
likely to be younger than those with lower happiness. This
association was not present after intervention (P = 0.002).
In our results, there was significant relationship between
gender and happiness (P = 0.04); in particular, females
were happier than males. Study subjects with lower
incomes reported lower levels of happiness. There was a
significant inverse relationship between level of happiness
and dependency on other people, as people who were
dependent on others reported lower levels of happiness, but
after the training programme this relationship was not
observed (P = 0.004).
Table 1
Educational structure of exercise programme and key content areas
Target
population
Men and women – at least 65 years – having no
medical contraindication for physical activity
Method/
duration
Sessions had three stages as follows:
First stage: Warm-up that consists of 4 min of
running slowly and 6-min stretching. It includes
bending and straightening the limb, close to
and to distant organs from trunk, and rotation
of the neck and waist, in addition to bending
and straightening theme.
Second stage: Kinetic movements, including a
series of physical exercises in style upper and
lower extremities that is 5 min in the early
stages and increasing gradually by the end of
the sixth week to 10 min, and in the eighth
week reaching 15 min. Balance exercises
included balance while walking, walking back
and forth, along with balancing, transferring
weight from one foot to the other foot,
walking on tiptoes and soles of the feet, and
standing on one leg.
Third stage: Cooling stage (includes 5 min of
slow movements) and was used for three types
of appropriate music with type of training in
three stages (warm-up, movement and cooling).
Programme
costs
All the project costs were paid by the researchers’
personal funds.
Content
areas
Approval of experimental group was attracted
after sampling of eligible people and
explanation about stage of study, concepts that
are needed for exercise programme. After
passing the above processes, the experimental
group participated in the exercise programme
of 8 weeks.
Participants in the intervention group followed
an 8-week training programme. Exercise
programme was three times a week, in the
morning, at 10:30 in the public park.
M. Khazaee-pool et al.
50 © 2014 John Wiley & Sons Ltd

5. Table 3 shows a comparison of mean scores of happi-
ness and its dimensions based on the OHI in the expe-
rimental and control groups before and after the
intervention. Before intervention, there was no significant
difference between happiness status among the two groups
(P = 0.001). Using a paired t-test, after intervention there
was significant difference (P = 0.001). Moreover, after
intervention, there was a significant increase of happiness
subscales among the experimental group [self-esteem (P =
0.002), life satisfaction (P = 0.001), efficacy (P = 0.001),
positive mood (P = 0.004), mental health (P = 0.003) and
global happiness (P = 0.001)].
The results in Table 4 show the mean scores of happi-
ness based on the OHI in the experimental and control
groups after intervention. The mean scores of intervention
group was 42.64 ± 17.39, but in control group it was 37.83
Table 2
Demographic data of elders in the experimental and control groups
Demographic characteristics
Experimental group
Frequency (%) (n = 60)
Control group
Frequency (%) (n = 60) P value
Gender2
Male 43 (71.7) 40 (66.7) 0.04
Female 17 (28.3) 20 (33.3)
Marital status2
Married 53 (88.3) 51 (85)
Single 7 (11.7) 9 (15) 0.69
Education1
Under diploma 52 (86.7) 48 (80)
Diploma 5 (8.3) 7 (11.7) 0.1
University 3 (5) 5 (8.3)
Social support sources1
Spouse, children 51 (85) 48 (80)
Siblings 6 (10) 7 (11.7)
Friends 1 (1.7) 2 (3.3) 0.77
Relatives 2 (3.3) 3 (5)
Total 60 (100) 60 (100)
Work status1
Active 27 (45) 29 (48.3)
Inactive 21 (35) 20 (33.4) 0.82
Homemaker 12 (20) 11 (18.3)
Leisure time physical activity2
0.61
Yes 37 (61.7) 35 (58.3)
No 23 (38.3) 25 (41.7)
Income (Can$)1
0.004
<500 51 (85) 46 (76.7)
501–1000 6 (10) 12 (20)
>1001 3 (5) 2 (3.3)
Health insurance 0.58
Yes 47 (78.3) 45 (75)
No 13 (21.7) 15 (25)
Age (year) 73.3 ± 6.11 68.12 ± 5.6 0.002
Md ± SD range 65–89 65–89
1
In order to determine significant difference between groups, X2
was used.
2
In order to determine significant difference between groups, t-test was used.
Table 3
Mean scores of comparison in happiness characteristics before and after exercise programme between two groups after 2 months
Variables
Experimental group Control group
Mean
differences P value
Baseline Post-intervention Baseline Post-intervention
mean (SD) mean (SD) mean (SD) mean (SD)
Self-esteem 4.21 (2.11) 9.54 (1.82) 3.62 (1.79) 3.71 (1.88) +5.33 0.002
Life satisfaction 14.01 (6.2) 19.94 (6.01) 13.54 (6.43) 13.79 (6.39) +5.93 0.001
Efficiency 4.82 (2.18) 10.04 (2.13) 4.1 (2.33) 4.07 (2.38) +5.22 0.000
Positive mood 10.3 (4.03) 15.91 (3.97) 10.76 (3.37) 10.99 (3.4) +5.61 0.004
Mental health 7.97 (3.31) 12.83 (3.27) 7.25 (2.69) 7.48 (2.17) +4.86 0.003
Global happiness 42.64 (17.39) 62.07 (17.2) 37.54 (13.16) 37.83 (13.31) +19.43 0.001
Physical exercise programme and happiness
© 2014 John Wiley & Sons Ltd 51

6. ± 13.31, before intervention. However, after intervention, a
significant increase in happiness (62.07 ± 17.2) was found
among the experimental group (P = 0.001), and the hap-
piness proportion was increased approximately 50% than
before intervention.
Discussion
Major findings
This study aimed to examine the effects of an 8-week long
physical exercises programme on happiness among older
adults in Nowshahr, Iran. As previously mentioned, the key
issue of the article focused on happiness, and the OHI was
used in this study (validated by Noorbala and Alipoor in
Iran). However, one might argue that there are specific
questionnaires to measure each of the dimensions of hap-
piness inventory, such as life satisfaction, positive mood,
mental health, self-efficiency and self-esteem; the analysis
focused only on happiness and addressed five dimensions
of it.
The results showed that the mean happiness scores in
the control group did not increase after 2 months of follow-
up. Contrarily, after 2 months of exercise education pro-
gramme in the experimental group, the level of happiness
scores among older adults was significantly increased
42.64–62.07. Generally, the results showed that the level of
happiness scores significantly increased among the inter-
vention group than in the control group in subscales of
self-esteem, life satisfaction, efficacy, positive mood, mental
health and general happiness. This result was in accordance
with a study in Japan, which concluded that the influence
of regular exercise on subjective sense of burden among
community-dwelling caregivers of dementia patients
improved psychological factors such as nervousness, satis-
faction ratings of work, home life and social life (Hirano
et al. 2011).
Based on our results, however, there were no significant
age and physical health difference by gender; after physical
activity programme, women were happier than men. These
findings were consistent with the results of previously
reported study showing positive and significant associa-
tions between levels of physical activity and life satisfaction
by gender. In Grant et al.’s study (2009), the majority of
cases reported positive well-being, with 70% of men and
79% of women saying that they were moderately or very
satisfied with their lives (Grant et al. 2009). Also, Farmer
et al. suggested that men and women differentially reported
physical activity because of cultural expectations and
habits (Farmer et al. 1988). In contrast, Stubbe et al.
reported that life satisfaction and happiness decreased with
increasing age, and men were significantly more satisfied
with their lives and happier than women (Stubbe et al.
2007).
Also, results indicated that participants who received
the PEP were more confident in their ability to return to
physical activity compared with control group, while
before intervention there was inverse relationship between
age and confidence in the ability to return to physical
activity and happiness. It may be that physical activity
brings skills in confronting with health problems, and that
in turn those skills prepare older adults to engage in physi-
cal activity. However, there were some ambiguities in the
findings of studies; for example, some studies have shown
that lower levels of happiness are found among 35 and
62 years of age – middle age – across gender and countries
(Blanchflower & Oswald 2008). As Dear et al. reported,
life satisfaction was higher in young adults than in older
adults (Dear et al. 2002).
Our results show that there was a negative relationship
between income and level of happiness, and that people
with higher level of income were happier than those with
lower level of income, and confidence to adhering exercise.
These results were consistent with those of Acil et al., who
reported that physical exercise and self-efficacy were posi-
tively correlated with income level (Acil et al. 2008). It is
also possible that people who have higher income levels
have less exhausting jobs, making them less tired during the
day. Also, people with higher levels of income may be able
to manage their time and resources to maintain physical
exercise behaviour better than others. Consequently,
they have more interest and energy to engage in physical
exercise.
Physical activity and its influences on positive mood
The results of this study showed that a greater level of
physical activity was associated with positive mood (one of
the dimensions of happiness inventory). In intervention
groups, the more participants reported to receive exercise
programme, the less they had negative mood. These find-
ings were consistent with the results of previous studies
that show significant associations between low levels
of physical activity and depression in older women
(Ruuskanen & Ruoppila 1995, Williams & Lord 1997,
Table 4
Mean and standard deviation (SD) score of elder’s happiness
comparison after 8 weeks between intervention and control groups
Variable
Intervention Control Independent
t PMean SD Mean SD
Happiness 62.07 17.2 37.83 13.31 −5.86 0.001
M. Khazaee-pool et al.
52 © 2014 John Wiley & Sons Ltd

7. Kritz-Silverstein et al. 2001). Additionally, this finding indi-
rectly was supported with the notion of Acil et al. (2008),
who stated that PEP applied by patients with schizophrenia
in 10 weeks provided a positive effect on QOL and
increased their QOL (Acil et al. 2008). Thus, the PEP pro-
vided a significant improvement in terms of physical
domain consisting of overall physical activity, and in terms
of mental domain consisting of emotions, cognitive func-
tions and behaviours (P < 0.05). Moreover, Deslandes et al.
studied about identifying changes in depressive symptoms,
QOL and cortical asymmetry after aerobic activity. In his
study, participants attended control physical exercise for
two sessions per week for 12 months. They were evaluated
by depression scales (BDI, Hamilton Depression Rating
Scale, Montgomery-Asberg Depression Rating Scale) and
the Short Form Health Survey-36. In the intervention
group, depressive symptoms significantly decreased, and
functional capacity increased (assessed by physical tests),
which was not observed in the control group (Deslandes
et al. 2010). Depressed mood has negative effect on physi-
cal activities in older adults and restrict their participation,
which in turn may affect their happiness. It is possible that
the range in physical activity level is too narrow within the
sedentary older adults, thereby limiting the influence that
physical activity may have exerted on happiness domains.
Also, this study supported this notion that the higher levels
of physical activity had a positive effect on the Health-
Related Quality of Life (HRQL) domains related to physi-
cal health (i.e. physical function, role restrictions due to
physical and general health) than their more sedentary
peers. Therefore, following physically active lifestyle was
positively associated with components of mental health
among older adults as it was demonstrated in this study
and previous study results (Rejeski & Mihalko 2001).
Physical activity and its influence on life satisfaction
In our study, it was shown that life satisfaction increased
through physical exercise intervention, which may improve
participants’ happiness. After the PEP, all of the partici-
pants in the intervention group reported that they have
been feeling more relaxed, cheerful and healthy, which
created a sense of life satisfaction. Some of them even stated
that they found themselves more active in daily activities. In
other words, PEP could enhance social interaction. Satis-
faction with participation may represent older adults’
adaptation and selection of physical activities that are most
important to them. These results strongly indicated that the
level of life satisfaction was improved by an appropriate
habitual intervention through the reduction of negative
moods and improvement in both physical and psycholo-
gical symptoms. Moreover, increasing regular physical
activity in daily lives can be expected to have a positive
psychological effect, and it was reported that physical exer-
cises improved psychological factors such as nervousness,
satisfaction ratings of work, home life and social life, and
finally QOL (Martin et al. 2009). Therefore, it can be said
that if physical exercise is used in association with other
psychosocial approaches, it has positive contribution to the
happiness of older adults, and may lead to much more
significant improvement in mental states and happiness of
older adults.
Physical activity and its influence on self-efficacy
Findings of this study suggest increasing self-efficacy com-
ponents in intervention group after the physical exercise
program may enhance their happiness. Furthermore, a
positive correlation was found between moderate physical
activity and self-efficacy, and the consequences of this cor-
relation were maintained 8 weeks post-intervention. There-
fore, encouraging participants to do more physical activity
could potentially act as an effective way to promote self-
efficacy in older adults. Also, it may give them a sense of
accomplishment and will reinforce their healthy physical
activity habits, which can possibly improve their self-
efficacy sense. This finding was indirectly supported by the
notion of McNeill et al. (2006), who also showed that
physical environment perceptions influence individual’s
physical activity through motivation and self-efficacy in a
diverse sample of adults. In general, self-efficacy was
closely related to the levels of physical activity, as was
reported on the study on self-efficacy of older people who
continue the physical activity programme (Allison & Keller
2004). This fact can be thought us, participation of older
adults in physical exercise improve their self-efficacy sense
through increasing their social interactivity.
Physical activity and its influence on self-esteem
We observed that self-esteem was improved by physical
exercise intervention. This is consistent with the previous
findings reported by Acil et al. (2008), who stated that after
a regular physical exercise intervention implemented for
patients with schizophrenia, the overall conditions, such
as general well-being, self-esteem and self-confidence, of
patients were improved. Similarly, another study conducted
on younger adolescents found a positive effect of physical
activity on self-esteem (Schmalz et al. 2007).This was
in contrast with previous research conducted on 11- to
15-year-old group adolescents that found no significant
association between physical activity and self-esteem
(Huang et al. 2007). However, another research finding
reported that physical exercise boosted memory, built
Physical exercise programme and happiness
© 2014 John Wiley & Sons Ltd 53

8. self-esteem, removed depression and increased mental
alertness. As a result, greater physical health and deeper
emotional well-being were developed among the partici-
pants. Also, many scientific researches show remarkable
preventive and treatment effects of physical exercise on
depressive mood (e.g. Blumenthal et al. 2007) and cogni-
tive performance (e.g. Andel et al. 2008). Exercise was also
found to positively affect self-concept, stress management,
control orientation (e.g. Alfermann & Stoll 2010) and
current mental state. It was shown that self-esteem levels
can be raised through positive experiences with physical
activity. As reported, motivation and self-esteem had direct
and mutual relationship, and regular exercise was shown as
an important tool to build self-esteem and fight depression
(Huang et al. 2007). Physical exercise participation in a
group might boost self-confidence in older adults and
enhanced their team activity. Besides, physical exercise may
potentially enhance immunological function of the human
body. Therefore, in this study we identified the most impor-
tant factors and effective steps to improve older adults’
health. It was thought that the implemented physical edu-
cational programme has had enormous positive impacts on
happiness in older adult.
Physical activity and its correlation with mental health
In our study, we found positive relationship between PEP
and mental health components of happiness inventory
among the intervention group, when they were compared
with the control group. There are few new studies in the
area of physical activity and mental health, but many of
them remain to be clarified with respect to evidence of
physical activity and its diverse mental health outcomes.
Our findings were consistent with the findings of previous
study that examined the effects of exercise (moderate-
intensity PEP three times a week) on coping self-efficacy
and depression. Craft found that physical exercise contrib-
uted to increasing perceptions of coping self-efficacy
(beliefs in one’s abilities to cope with stress), and this was
associated with lower reported depression. Craft noted that
‘in light of the fact’, women in the intervention group had
significantly higher coping self-efficacy. She suggested that
by goal setting and skill development in a supportive social
environment, the programme contributed to enhancing
participants’ beliefs on utilizing physical exercise to cope
with depression (Craft 2005). In another direction, Motl
et al. examined the effects of physical activity on depression
among older adults. In his study, participants were ran-
domly assigned to walking and training group. Before
and 6, 12 and 60 months after intervention, depression
was evaluated. Results showed that depressive symptoms
decreased after intervention and in the duration of 12 and
60 months (Motl et al. 2005).
Another randomized controlled trial examined the effec-
tiveness of an endurance exercise programme on depres-
sion and anxiety in sedentary older adults. Participants
were randomized to aerobic exercise group (ergometer
cycle sessions three times/week at a heart rate correspond-
ing to ventilator threshold intensity) and control group.
After 6 months of training, the authors found a significant
decrease in depression and anxiety scores, and an improve-
ment in the QOL among the intervention group, but it
remained within the control group (Antunes et al.
2005).This finding was supportive of our study, which
showed the effectiveness of physical exercise training for
improving mental health among older adults, and showed
a relationship between greater levels of physical activity
and higher levels of mental health. That was not easy to say
that the lower levels of physical activity cause problems of
mental health. It might be the case that the less mental
health an individual has, the less likely he/she engages in
physical activity.
Study limitations and implications
The current study provided evidence for the significance
of the physical activity on happiness among older adults.
It was among the few studies that concurrently considered
physical activity and level of happiness among older adults.
However, several limitations of the present study should
be noted. First is sampling bias. The study might have
attracted volunteer participants. Second is social desirabil-
ity bias. As data collection was conducted in public parks,
biased responses might occur even though participants
were informed that each question should be answered as
honestly as possible. Third is sample size. The results of this
study are difficult to generalize because the number of
participants is limited. Fourth is time limitation. This study
was conducted in a short period of time, and long-term
consequences of physical exercise have not been investi-
gated. For this reason, it might be useful to investigate its
consequences on a larger sample size and in longer time.
Last is the lack of evaluation of other factors (except demo-
graphic characteristics and physical exercise) that related to
happiness because multiple factors may lead to greater or
lower level of happiness in a specific population.
Recommendation
Although there were some limitations in this study, the
findings have had important and sufficient implications for
health professionals who provide services for older adults.
The PEP is a new, cheap, effective, easily applicable and
M. Khazaee-pool et al.
54 © 2014 John Wiley & Sons Ltd

9. readily available method for which the available facilities
would be sufficient as an alternative approach for support-
ing older adults. Counselling intervention is one of the
specific strategies for encouraging older adults to engage in
physical activities that are appropriate to their level of
physical fitness and individual preferences. Therefore, we
recommend multidimensional and long-term studies to
provide generalized evidence about the effects of physical
activity and other factors on the happiness and general
health of older adults. Additionally, the team would like to
recommend designing programmes that provide informa-
tion about the importance of physical activity for further
improvement of elements associated with happiness, like
self esteem, self-efficacy, positive mood, and in turn QOL.
Conducting longitudinal studies about happiness and
physical activity is recommended to find out more about
the precise effects of happiness on physical activity.
Conclusions
Few studies have been undertaken to investigate the
relationship between happiness and physical activity
among older adults, but our study has documented posi-
tive effects of physical activity on happiness and its
dimensions, including self-efficacy, self-esteem, positive
mood and mental health, despite the limitations listed
above. Thus, maintaining a physically active lifestyle
contributes to happiness of older adults. Due to the
rising costs of the health-care system, it would be rela-
tively cost-effective, especially considering the effects of
physical activity, to improve the QOL and well-being of
a wide range of older adults (Cobiac et al. 2009, Gesell
et al. 2013, Wilbur et al. 2013). As the number of older
adults increases, the use of efficient strategies will be
important in enhancing physical activity in this group.
Because older adults are faced with many barriers to
exercise, designing cost-effective interventions remains
an important priority that enables participants not only
to initiate physical exercise, but also to maintain it rou-
tinely over the long term. This is, in fact, important as
health economic evaluations of such interventions have
the potential to provide governments and payers with
better insights on how to spend the available financial
resources in a more efficient way.
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Appendix I OXFORD HAPPINESS INVENTORY
Questions
Strongly
disagree
Fairly
disagree
Fairly
agree
Strongly
agree
1. I am incredibly happy.
2. I feel sure that the future is overflowing with hope and promise.
3. I am totally satisfied with everything.
4. I feel that I am in total control of all aspects of my life.
5. I feel that life is overflowing with rewards.
6. I am delighted with the way I am.
7. I always have a good influence on events.
8. I love life.
9. I am intensely interested in other people.
10. I can make all decisions very easily.
11. I feel able to take anything on.
12. Nowadays I always wake up feeling more rested than I used to.
13. I feel I have boundless energy.
14. The whole world looks beautiful to me.
15. I have never felt so mentally alert as I do nowadays.
16. I feel on top of the world.
17. I love everybody.
18. All past events seem extremely happy.
19. I am constantly in a state of joy and elation.
20. I have done everything I ever wanted.
21. My time is perfectly organized so that I can fit in all the things I want to do.
22. I always have fun with other people.
23. I always have a cheerful effect on others.
24. My life is totally meaningful and purposive.
25. I am always committed and involved.
26. I think the world is an excellent place.
27. I am always laughing.
28. I think I look exceptionally attractive.
29. I am amused by everything.
Physical exercise programme and happiness
© 2014 John Wiley & Sons Ltd 57