Ongoh et al.

Journal of Health, Population and Nutrition (2024) 43:164 Journal of Health, Population
https://doi.org/10.1186/s41043-024-00655-8
and Nutrition

RESEARCH Open Access

Daily exercises uptake and associated factors

among Social Security and National Insurance
Trust pensioners in the Greater Accra Region
of Ghana
Myles Ongoh1*, Kwamina Abekah-Carter2, Edmond A-iyeh3 and Williams Agyemang-Duah4

Abstract
Background With a growing body of evidence highlighting the positive impact of regular physical activity or
exercise on achieving healthy aging, it is important to gain insight into the factors influencing daily exercises uptake.
However, to the best of our knowledge, no study has been focused on factors predicting daily exercises uptake
among pensioners, who form a substantial portion of Ghana’s aging population. The goal of this preliminary study
was to estimate the factors associated with daily exercises uptake among Social Security and National Insurance Trust
(SSNIT) pensioners in Ghana.
Methods Data for this study came from a cross-sectional study on survival strategies and quality of life among SSNIT
pensioners in the Greater Accra Region of Ghana. Cluster and stratified sampling techniques were used to recruit
the study participants. The analytic sample was 410 participants. Multivariable binary logistic regressions were used
to estimate factors associated with daily exercises uptake among the participants. The significance of the test was
pegged at a p-value of 0.05 or less.
Results The results showed that 62% of the participants self-identified as male, 47.6% were aged between 60
and 64 years, 52.7% were employed in the public sector and 44.4% performed daily exercises. The results showed
that those who were aged 60–64 years (AOR: 1.197, 95% CI: 1.019–1.405), aged 65–69 years (AOR:1.254, 95% CI:
1.071–1.468), who do not incur expenditure on their household in a month (AOR: 1.519, 95% CI: 1.127–2.046), earned
less than GH¢260 (AOR: 1.221, 95% CI: 1.018–1.465), accessed/utilized herbalist medical services (AOR: 1.252, 95%
CI: 1.129–1.388), very dissatisfied (AOR: 1.637, 95% CI: 1.242–2.157) and dissatisfied (AOR: 1.516, 95% CI: 1.212–1.896)
with their sex life were more likely to undertake daily exercises and this was statistically significant. The results again
demonstrated that participants who joined fitness club (AOR: 0.685, 95% CI: 0.614-0.764) and those who were very
dissatisfied with their health services access/use (AOR: 0.598, 95% CI: 0.363-0.984) were less likely to undertake daily
exercises and this was statistically significant.

*Correspondence:
Myles Ongoh
tibanye@yahoo.com
Full list of author information is available at the end of the article

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
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Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 2 of 11

Conclusion Findings of this study have provided important insights for policy makers and thus constitute a useful
framework to help plan and shape future policies and programs on daily exercises uptake among pensioners in
Ghana and other geographical contexts with similar cultural, demographic, and socio-economic characteristics.
Keywords Daily exercises uptake, Social Security and National Insurance Trust, Pensioners, Ghana

Introduction [23]. Results from a study that examined the relationship

Geographical territories worldwide are experiencing a between physical activity and incidence of coronary heart
shift in their demographics that is characterized by an and cardiovascular illnesses among female older persons
aging population. It is estimated that the total global suggested that physical activity had a role in preventing
number of persons aged 60 years and above is about these diseases among the study population [24].
one billion, with expectations that by 2050, this number A systematic review also found that physical activ-
would increase by about 100% [1]. In Ghana, the popu- ity improves cardiovascular outcomes among the aging
lation of persons aged 60 years and above accounts for population [25]. Furthermore, physical activity or exer-
over 6% of the national population [2], and projections cise could reduce one’s risk of mobility issues [26], reduce
made suggest that this proportion will rise to about 9.8% the risk of falls [27], alleviate the fear of falling, improve
by 2050 [3]. The pensioner demographic, specifically balance sureness, quality of life, and physical perfor-
those retiring from the formal workforce after reaching mance [28, 29]. Physical activity or exercise also has a
statutory retirement age, constitutes a significant part positive association with mental health. In Callow et
of this demographic shift [4, 5]. For instance, in Ghana, al.’s [30] study on the advantages of physical activity on
the mandatory retirement age for most formal sector the mental wellbeing of older people in North America,
workers is sixty years [6], aligning with the country’s age it was revealed that older persons who were involved in
definition of an older person [7]. While the persistent greater levels of physical activity had a low risk of hav-
increase in the number of older persons could be attrib- ing depressive symptoms. Likewise, a study that dis-
uted to advancements in health care and living condi- cussed the effects of physical inactivity among older
tions [8, 9], the aging process is still associated with the persons indicated that physically active older persons had
probable onset of ailments and the loss of functional a low risk of experiencing cognitive decline, dementia,
capabilities that are determined by diverse genetic, envi- Alzheimer’s disease, and depression [31]. Additionally, a
ronmental, routine, and physical issues [10–12]. More- study that assessed the impact of living alone on psycho-
over, retirement could be viewed as a social stress that logical distress among older persons in Ghana found that
can adversely affect one’s physical and mental health [13]. physical activity, including walking, dancing, sporting,
Consequently, as people transition to retirement, sustain- and gardening could significantly reduce the negative link
ing a healthy lifestyle becomes imperative for a rewarding between living alone and emotional anguish [32]. Given
and active life post-work life [14]. the benefits of exercise, the Ministry of Health in Ghana
Physical exercise is an essential factor of a healthy life- recommends that older persons engage in 2.5 h of aero-
style, and its importance to the aging population, includ- bic activity and two sessions of muscle-firming activities
ing pensioners cannot be overemphasized. Exercise can each week [33].
be defined as regular, structured activity aimed at achiev- With a growing body of evidence shedding light on
ing suitable fitness outcomes, such as improving over- the positive impact of regular physical activity or exer-
all health and physical abilities [15, 16]. It is an essential cise on achieving healthy aging, it is important to gain
physical activity routine that is useful to social adjust- insight into the factors influencing daily exercises uptake.
ment, mental health, and cognitive function [17]. Some Some studies have reported that physical activity among
examples of exercise include walking, jogging, balance older persons could be influenced by several variables,
and stability exercise, cardiovascular exercise, flexibil- including sex [34] and marital status [35]. Furthermore,
ity exercise, bodyweight exercise, and strength training. the availability of social support [36, 37], personal moti-
In emphasizing the relevance of exercises, some experts vation factors [38–40], and the availability of requisite
note that physical inactivity does not only represent training facilitates could inform a person’s decision to
a loss of human potential, but it is also a risk factor for exercise [39]. However, information on the daily exercise
functional disability, poor health, and death [13, 15, 18]. uptake among Ghana’s aging population and the factors
Whereas physical activity may sometimes result in inju- that shape these behaviors remains scant as not much has
ries and health complications [19], its positive effects been done to explore this issue. Only few studies, such as
outweigh the negatives [20]. Exercise contributes to slow- Balis et al. [33] have identified factors, such as peer influ-
ing the progression of chronic conditions [21], and main- ence, as well as suggestions from healthcare providers
taining aerobic capacities [22], muscle mass, and strength
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 3 of 11

to be influential in older adults’ participation in physical Research design

activities in Ghana. Data for this study came from a cross-sectional mixed
To the best of our knowledge, no study has been done methods study on survival strategies and quality of life
to examine this topic among pensioners, who form a among SSNIT pensioners in the Greater Accra Region
substantial portion of Ghana’s aging population. Accord- of Ghana. This study specifically focused on an aspect of
ingly, this study sought to supplement existing literature the larger cross-sectional mixed methods study, which
by investigating the daily exercises uptake and associated looked at daily exercise uptake among SSNIT pensioners.
factors among Social Security and National Insurance
Trust (SSNIT) pensioners in the Greater Accra Region of Sampling procedure
Ghana. Thus, the objective of this study was to explore In this study, we focused on SSNIT pensioners because
factors influencing daily exercises uptake among pension- SSNIT is the largest manager of pension funds in Ghana.
ers in the Greater Accra Region of Ghana. This research Using Yamane [42] formula for sample size estimation,
N
is significant because by identifying the factors that influ- n = 1+Ne 2 [where n= the minimum sample size, z= the
ence daily exercises among this social group, healthcare desired level of confidence level of 95% and the z-score
officials, policymakers, and pensioners themselves could corresponding to 95% confidence level=1.96, N= is pop-
use this information to develop relevant interventions ulation of pensioners in Greater Accra Region from the
and strategies to improve overall health and quality of life records of SSNIT in December 2016 was 49, 673 [43] and
during retirement. e= is the degree of precision which would be assumed to
be 5%, hence p=0.05], we estimated a minimum sample
Data and methods size of 397. To cater for a non-response rate, we calcu-
Settings lated a 10% non-response rate, resulting in a final sam-
Located in the South-Eastern part of Ghana, Greater ple size estimation of 437 pensioners. Participants were
Accra Region shares boundaries with Eastern Region to selected using stratified and cluster sampling techniques.
the North, Volta Region to the East, Central Region to The estimated sample size for this study was 437 pension-
the West and Gulf of Guinea to the South with a total ers. However, there were 27 missing values in some of the
land area of 3, 245 km2 [41] as indicated in Fig. 1. Evi- variables considered in this study. These were therefore
dence suggests that the Greater Accra Region of Ghana excluded from the analysis. Hence, the analytic sample
has the highest pensioner population in Ghana making it for this study was restricted to 410 participants.
an ideal location for this study.

Fig. 1 Map of Greater Accra in the context of Ghana

Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 4 of 11

Data collection procedure and ethics (GH¢) (0 = less than 260, 1 = 260–859, 2 = 860 or more
A structured questionnaire was used as the data col- 3 = did not disclose their income). Lifestyle/health-related
lection instrument. It was designed in English and pro- factors included the use of herbalist medical services
grammed on mobile devices with an electronic tool called (0 = no, 1 = yes), joining of fitness club (0 = no, 1 = yes),
Insyt; an easy, fast, robust, and flexible tool for collecting satisfaction with health services access/use (0 = very dis-
data. Institutional ethics approval was obtained from the satisfied, 1 = dissatisfied, 2 = neutral, 3 = satisfied 4 = very
College of Humanities at the University of Ghana, Legon dissatisfied), satisfaction with sex life (0 = very dissatis-
(Ref: ECH 006/18–19). Both informed written and verbal fied, 1 = dissatisfied, 2 = neutral, 3 = satisfied 4 = very dis-
consent were obtained from the participants. Detailed satisfied) and satisfaction with health status (0 = very
information on the methods, including the data collec- dissatisfied, 1 = dissatisfied, 2 = neutral, 3 = satisfied
tion procedure, has been reported elsewhere [5, 44]. 4 = very dissatisfied). Due to the several independent
variables considered in the analysis, multicollinearlity
Measurement analysis was performed as demonstrated in Table 1. The
In this study, our dependent variable was daily exercise variance inflation factor (VIF) for all the independent
uptake. Participants were asked, have you been under- variables was less than 5, showing no multicollinearity.
taking daily exercises? The response was a dichotomous
variable, that is, “no = 0” or ‘yes = 1. The independent vari- Analytical framework
ables were classified into demographic, socio-economic In this study, both descriptive and inferential analyti-
and lifestyle/health-related variables. Demographic vari- cal frameworks, embedded in SPSS software version 25,
ables were sex (0 = male, 1 = female), religion (0 = Chris- were employed. Specifically, descriptive statistics such
tian, 1 = non-Christian), age (years) (0 = 60–64, 1 = 65–69, as frequency and percentage were used to determine
2 = 70 or more), marital status (0 = consensual union, the sample characteristics of the participants. Informed
1 = married, 2 = never married/Separated, 3 = widowed), by the dichotomous dependent variable, multivariable
household size (0 = 1–5, 1 = 6–10, 2 = above 10), house- binary logistic regression analysis as an inferential ana-
hold head (0 = no, 1 = yes) and years on retirement lytical framework was used to estimate the association
(0 = less than 5, 1 = 5–9, 2 = 10 or more). Socio-economic between the dependent variable (daily exercises uptake)
variables were expenditure on household (GH¢) (0 = less and independent variables (demographic, socio-eco-
than 500, 1 = 500–999, 2 = 1000–1499, 3 = 1500 or more), nomic and health-related/lifestyle factors). In apply-
education level (0 = none, 1 = primary/JHS/middle school, ing the multivariable binary logistic regression, three
2 = secondary, 3 = vocational/technical, 4 = tertiary), models were fitted to determine factors associated with
employment sector (0 = public, 1 = private), occupation daily exercises uptake among the participants. More
(0 = administrative/managerial/clerical, 1 = civil/public specifically, Model 1 comprised demographic variables.
service, 2 = entrepreneur/industrialist, 3 = production Model 2 consisted of demographic and socio-economic
work, 4 = teacher/lecturer, 5 = other) and monthly income variables. Model 3 (final Model) captured demographic,
socio-economic and lifestyle/health-related variables.
Table 1 Multicollinearlity analysis
The final model (3) thus serves as the result used for the
Variables Tolerance VIF
discussion. Adjusted Odds Ratio (AOR) and Confidence
Sex 0.633 1.579
Interval (CI) with p-value of 0.05 or less were reported as
Religion 0.951 1.052 significant.
Age (years) 0.485 2.061
Years on retirement 0.489 2.047 Results
Marital status 0.713 1.403 Sample characteristics of the participants
Household Size 0.807 1.239 Table 2 provides information on the sample characteris-
Household head 0.750 1.333 tics of the participants. The analysis showed that 62% of
Expenditure on dependents (GH¢) 0.855 1.169 the participants self-identified as male, 82.4% were Chris-
Education 0.871 1.147 tians, 47.6% were aged between 60 and 64 years, 70.2%
Employment 0.863 1.159 were married, 54.6% had a household size between 1 and
Occupation 0.895 1.117 5 persons and 82.4% were household head. Also, 42.4%
Monthly Income (GH¢) 0.868 1.152 of the participants spent between GH¢500–999 on their
Herbalist 0.887 1.127 household in a month and 42.4% had been on retire-
Fitness Club 0.931 1.074 ment for less than 5 years. Again, 35.6% of the partici-
Satisfaction with health status 0.873 1.146 pants had a primary/JHS/Middle school education, 52.7%
Satisfaction with sex life 0.880 1.136 were employed in the public sector and were engaged
Satisfaction with health services 0.827 1.209 in production work (25.9%) and 55.1% earned between
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 5 of 11

Table 2 Sample characteristics of the participants

Variables Responses N = 410 Percent
Daily exercises Yes 182 44.4
No 228 55.6
Sex Male 254 62.0
Female 156 38.0
Religion Christian 338 82.4
Non-Christian 72 17.6
Age (years) 60–64 195 47.6
65–69 138 33.7
70 or more 77 18.7
Marital status Consensual union 10 2.5
Married 288 70.2
Never married/Separated 37 9.0
Widowed 75 18.3
Household size 1–5 224 54.6
6–10 153 37.3
Above 10 33 8.1
Household head Yes 338 82.4
No 72 17.6
Years on retirement Less than 5 years 174 42.4
5–9 years 144 35.1
10 years or more 92 22.5
Expenditure on household (GH¢) None 10 2.5
Less than 500 126 30.7
500–999 174 42.3
1000–1499 41 10.0
1500 or more 59 14.5
Education None 3 0.7
Primary/JHS/Middle School 146 35.6
Secondary 53 12.9
Vocational/Technical 64 15.6
Tertiary 144 35.2
Employment sector Public 216 52.7
Private 194 47.3
Occupation Administrative/Managerial/Clerifical 70 17.1
Civil/Public Service 94 22.9
Entrepreneur/Industrialist 20 4.9
Production Work 106 25.9
Teacher/Lecturer 77 18.8
Other 43 10.5
Monthly income (GH¢) Less than 260 47 11.5
260–859 226 55.1
860 or more 95 23.2
Did not disclose 42 10.2
Use of herbalist medical services Yes 98 23.9
No 312 76.1
Joining of Fitness Club Yes 81 19.8
No 329 80.2
Satisfaction with health services access/use very dissatisfied 4 1.0
Dissatisfied 102 24.9
Neutral 184 44.9
Satisfied 106 25.9
Very satisfied 14 3.3
Satisfaction with sex life very dissatisfied 24 5.9
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 6 of 11

Table 2 (continued)
Variables Responses N = 410 Percent
Dissatisfied 197 48.0
Neutral 104 25.4
Satisfied 69 16.8
very satisfied 16 3.9
Satisfaction with health status very dissatisfied 7 1.7
Dissatisfied 45 11.0
Neutral 138 33.7
Satisfied 220 53.6

GH¢260–859 as a retirement benefit every month. Fur- in a month were 1.519 times statistically significantly
ther, 23.9% of the participants used herbalist medical more likely to undertake daily exercises compared to
services, 19.8% joined fitness club, 25.9% were satisfied those who incurred (AOR: 1.519, 95% CI: 1.127–2.046).
with health services access/use, 53.7% were satisfied with We found that those who earned less than GH¢260 in a
their health status and 48% were dissatisfied with their month were 1.221 times statistically significantly more
sex life. Lastly, 44.4% of the participants performed daily likely to undertake daily exercises (AOR: 1.221, 95% CI:
exercises. 1.018–1.465).
The results further revealed that participants who
Main regression analysis accessed/utilized herbalist medical services were 1.252
The factors associated with daily exercises uptake among times statistically significantly more probable to under-
the participants are reported in Table 3. In Model 1, take daily exercises compared to those who did not
the results showed that participants aged between 65 access medical services from herbalists (AOR: 1.252, 95%
and 69 years were 1.309 times statistically significantly CI: 1.129–1.388). The results again provide evidence that
more likely to undertake daily exercises compared to participants who joined fitness club were 0.685 times
those who were 70 years or more (Adjusted Odds Ratio less likely to undertake exercises compared to those who
[AOR]: 1.309, 95% CI: 1.098–1.560). In Model 2, when did not join fitness club, and this was statistically sig-
socio-economic variables were added to all variables in nificant (AOR: 0.685, 95% CI: 0.614-0.764). Additionally,
Model 1, the results demonstrated that those who were the results showed that participants who were very dis-
aged between 65 and 69 years were 1.286 times statisti- satisfied with their health services access/use were 0.598
cally significantly more probable to undertake daily exer- times less likely to undertake daily exercises compared to
cises compared to those who were 70 years or over (AOR: those who were very satisfied with health services access/
1.286, 95% CI: 1.078–1.535). Comparatively, the adjusted use, and this was statistically significant (AOR: 0.598,
odds ratio for those aged 65–69 years reduced from 95% CI: 0.363-0.984). The results also indicated that par-
1.309 in Model 1 to 1.286 in Model 2. This implies that ticipants who were very dissatisfied (AOR: 1.637, 95%
socio-economic variables slightly weaken the association CI: 1.242–2.157) and dissatisfied (AOR: 1.516, 95% CI:
between age and daily exercises uptake among the par- 1.212–1.896) with their sex life were statistically signifi-
ticipants. In Model 2, the results showed that those who cantly more likely to engage in daily exercise compared
earned between GH¢260–859 in a month were 1.193 to those who were satisfied with their sex life, with odds
times statistically significantly more likely to undertake ratios of 1.637 and 1.516, respectively. In summary, the
daily exercises (AOR: 1.193, 95%CI: 1.015–1.402). Again, results based on the final model have demonstrated that
the results indicated that those who did not incur expen- age, household expenditure, monthly income, use of
diture on their household were 1.407 times statistically medical services by herbalists, joining fitness club, satis-
significantly more likely to undertake daily exercises faction with sex life and satisfaction with health services
compared to those who spent GH¢1,500 or more on their access/use were statistically significantly associated with
household in a month (AOR: 1.407, 95% CI: 1.016–1.949). undertaking of daily exercises among the participants
In the final model (3), the results showed that par- (see Table 3).
ticipants who were aged 60–64 years (AOR: 1.197, 95%
CI: 1.019–1.405) and those who were aged 65–69 years Discussion
(AOR:1.254, 95% CI: 1.071–1.468) were 1.197 and 1.254 This study explored the factors that influence daily exer-
times respectively, statistically significantly more likely cises uptake among pensioners in the Greater Accra
to undertake daily exercises compared to those who were Region of Ghana. The findings supplement extant lit-
aged 70 years or over. The results showed that partici- erature on this research area and highlight the need for
pants who did not incur expenditure on their household holistic approaches that consider socio-demographic and
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 7 of 11

Table 3 Factors associated with daily exercises uptake among retired personnel in Ghana
Model 1 Model 2 Model 3 (Final Model)
95% CI for AOR 95% CI for AOR 95% CI for AOR
DEMOGRAPHIC AOR Lower Upper AOR Lower Upper AOR Lower Upper
Sex
Male 1.033 0.920 1.161 1.014 0.902 1.141 0.965 0.869 1.073
Female (ref ) 1.00 1.00 1.00
Religion
Christian 1.082 0.956 1.224 1.059 0.933 1.202 1.038 0.927 1.163
Non-Christian (ref ) 1.00 1.00 1.00
Age (years)
60–64 1.142 0.958 1.360 1.105 0.924 1.321 1.197* 1.019 1.405
65–69 1.309** 1.098 1.560 1.286** 1.078 1.535 1.254** 1.071 1.468
70 or more (ref ) 1.00 1.00 1.00
Marital Status
Consensual union 0.745 0.533 1.042 0.785 0.562 1.098 0.859 0.635 1.162
Married 0.894 0.778 1.028 0.931 0.809 1.071 1.015 0.894 1.154
Never married/Separated 0.860 0.709 1.045 0.852 0.703 1.033 0.947 0.797 1.127
Widowed (ref ) 1.00
Household Size 1.00 1.00
1–5 0.938 0.782 1.126 0.970 0.804 1.171 0.865 0.317 2.360
6–10 0.974 0.810 1.172 0.968 0.802 1.167 0.903 0.330 2.469
Above 10 (ref ) 1.00 1.00 1.00
Household Head
Yes 0.884 0.768 1.017 0.908 0.789 1.045 0.978 0.863 1.110
No (ref ) 1.00 1.00 1.00
Number of Years on Retirement
Less than 5 years 0.891 0.750 1.058 0.935 0.789 1.109 0.890 0.764 1.036
5–9 years 0.897 0.759 1.059 0.933 0.791 1.101 0.885 0.763 1.026
10 years or more (ref ) 1.00 1.00 1.00
SOCIO-ECONOMIC FACTORS
Education
None 0.906 0.520 1.578 0.787 0.480 1.291
Primary/JHS/Middle School 1.022 0.902 1.158 1.034 0.924 1.156
Secondary 1.087 0.923 1.281 1.038 0.896 1.203
Vocational/Technical 1.004 0.865 1.165 1.025 0.898 1.170
Tertiary (ref ) 1.00 1.00
Employment Sector
Public 1.061 0.913 1.232 0.977 0.853 1.120
Private (ref ) 1.00
Occupation
Administrative/Managerial/Clerical 0.951 0.789 1.147 0.966 0.816 1.144
Civil/Public Service 0.939 0.780 1.130 0.976 0.825 1.155
Entrepreneur/Industrialist 0.930 0.712 1.215 0.865 0.681 1.099
Production Work 1.057 0.876 1.276 0.995 0.841 1.177
Teacher/Lecturer 0.837 0.687 1.019 0.885 0.742 1.057
Other (ref ) 1.00 1.00
Monthly Income (GH¢))
Less than 260 1.199 0.977 1.471 1.221* 1.018 1.465
260–859 1.193* 1.015 1.402 1.096 0.946 1.269
860 or more 1.005 0.835 1.210 1.015 0.861 1.197
Did not disclose their income (ref ) 1.00 1.00
Expenditure on Household (GH¢)
None 1.407* 1.016 1.949 1.519** 1.127 2.046
Less than 500 1.050 0.906 1.218 1.062 0.928 1.215
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 8 of 11

Table 3 (continued)
Model 1 Model 2 Model 3 (Final Model)
95% CI for AOR 95% CI for AOR 95% CI for AOR
DEMOGRAPHIC AOR Lower Upper AOR Lower Upper AOR Lower Upper
500–999 1.077 0.885 1.310 1.117 0.937 1.331
1000–1499 1.040 0.890 1.215 1.033 0.897 1.189
1500 or more (ref ) 1.00 1.00
LIFESTYLE/HEALTH-RELATED
Use of Herbalist Medical Care
Yes 1.252*** 1.129 1.388
No (Ref ) 1.00
Joining of Fitness Club
Yes 0.685*** 0.614 0.764
No (ref ) 1.00
Satisfaction with Health Services
very dissatisfied 0.598* 0.363 0.984
Dissatisfied 1.085 0.847 1.390
Neutral 1.059 0.832 1.349
Satisfied 1.231 0.964 1.572
Very satisfied (ref ) 1.00
Satisfaction with Sex Life
very dissatisfied 1.637*** 1.242 2.157
Dissatisfied 1.516*** 1.212 1.896
Neutral 1.552*** 1.237 1.947
Satisfied 1.248 0.987 1.578
very satisfied (ref ) 1.00
Satisfaction with Health Status
very dissatisfied 0.976 0.702 1.355
Dissatisfied 1.004 0.869 1.160
Neutral 1.026 0.932 1.129
Satisfied (ref ) 1.00
NB: Italic and asterisks values and indicate significance of the test
*Test is significant at the 0.05 level
** Test is significant at the 0.01 level
*** Test is significant at the 0.001 level

lifestyle/behavioural factors when formulating and imple- poor health, which also hindered their functional capa-
menting policies and programs intended to promote bility, increased with age among both older women and
healthy lifestyles among older persons during retirement. older men. Moreover, some older persons assume poor
The findings of this research suggest that pensioners health as an inevitable result of aging, and thus, they are
within the age bracket of 65 and 69 years are more likely not motivated to adopt healthy behaviours like exercise
to undertake daily exercises compared to those who are [48]. Furthermore, Rai et al.’s [49] study, which explored
70 years or above. This finding corroborates the results of physical activity among retired older persons also found
a systematic review, which reported that various forms of that even with heightened demands during their working
physical activities progressively decrease with age among days, some retirees believed that the nature and structure
older persons [45]. It is also partly consistent with the of their work provided a framework that facilitated the
findings of Ishikawa-Takata et al. [46], which indicated incorporation of exercise into regular routines, thereby
that physical activity was significantly higher among preventing procrastination. However, after retiring, some
older persons aged 65–74 years compared to those aged retirees faced challenges in adjusting to a post-retirement
75 years and above. routine; a factor they acknowledged as crucial for engag-
Some plausible reasons could be attributed to the ing in physical activity [49]. Therefore, promoting and
decline of exercise uptake among older persons as they providing support for the establishment of post-retire-
age. For instance, Debpuur et al.’s [47] research on the ment routines among pensioners could be useful in sus-
self-reported health and functional limitations among taining regular exercise behaviours.
older persons in Ghana revealed that the reportage of
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 9 of 11

Nonetheless, after accounting for socio-demographic likelihood of daily exercise uptake. It could be inferred
variables, the adjusted odds ratio for the association from this that barriers to healthcare access could nega-
between being aged 65–69 and daily exercises decreased tively influence individuals’ motivation for physical activ-
slightly, underscoring the importance of considering ity or exercise.
socio-economic factors in understanding and promoting Interestingly, this study found that pensioners who
exercises uptakes and general healthy behaviours among joined fitness clubs were less likely to exercise daily. For
older persons. The socio-economic factors that recorded some older persons, exercising in groups does not only
a significant association included earning between motivate them to continue this important routine [55],
GH¢260–859 and earning less than GH¢260 every but it has also been found to be effective in reducing
month. This finding is in line with Doubova et al.’s [50] risks of falls, functional decline, and depressive symp-
research, which reported that older adults with stable toms compared to exercising alone [56]. In addition to
income were more likely to engage in physical activities, the health benefits associated with participating in the
such as exercises. Nonetheless, an interesting observa- activities of fitness clubs, engaging in daily exercises
tion in this study’s finding is that the adjusted odds ratio could offer more health benefits to pensioners. There-
for engaging in daily exercises generally decreased as fore, most pensioners who join fitness clubs are likely
the monthly income increased. It is not too clear what to miss these additional health benefits associated with
accounts for this as extant evidence [e.g. 51] suggests that daily exercise because of their lower odds of engage-
sedentary time decreases with the increase of income. ment in daily exercise. We are of the view that engaging
Probably, the pensioners earning higher monthly income in daily exercise is expected to strengthen the health of
had either more sedentary behaviours or had alternative pensioners. This finding supports the need to encourage
forms of healthy lifestyles other than exercises. Conduct- pensioners who joined fitness clubs to exercise daily. The
ing research to explore the motivation for undertak- findings also indicated that pensioners who were dissatis-
ing exercise among older persons or pensioners earning fied with their sex life were more likely to participate in
lower and high incomes could be essential to increas- daily exercises. These pensioners may be motivated to
ing the depth of knowledge and providing clarity to this undertake daily exercises due to the belief that physical
issue. The study also found that pensioners who incurred fitness could lead to the improvement of sexual satisfac-
no household expenditure were more likely to engage tion [57]. Therefore, sensitization campaigns that focus
in daily exercises. This suggests that such pensioners on the relevance of exercises, as well as specific exercise
may be experiencing lower financial burdens, creating a routines that enhance sexual satisfaction should be pro-
conducive environment for prioritizing healthy habits, moted. However, it is also possible for the finding to sug-
including undertaking daily exercises. Thus, it would be gest a potential compensatory behavior, where engaging
useful if strategies geared towards improving daily exer- in regular exercise serves as a means for emotional regu-
cises uptake among pensioners or older persons include lation or distraction from sexual dissatisfaction. Seeking
enhancing financial access to physical activity opportuni- emotional relief through regular exercises emphasizes
ties [52]. an intricate interplay between psychological and lifestyle
The findings also show a significant potential asso- factors. It would be useful if research is conducted among
ciation between herbalist medical services and daily the aging population to offer a nuanced understanding
exercises uptakes. This supports the findings of exist- on this issue.
ing studies that have demonstrated the importance of Given the nature of this study, it is important to
herbal medicine for enhancing exercise performance. acknowledge its strength and limitations. The strength
For instance, a study conducted by Tao and colleagues of this study is that it remains the first study to be car-
[53] in China found that older persons who drank herbal ried out among pensioners in Ghana. It has thus con-
tea involved themselves in regular physical exercises. tributed empirically to knowledge by highlighting the
Additionally, a study conducted in Korea found that the specific demographic, socio-economic and lifestyle/
consumption of a traditional herbal mixture (known as health-related factors predicting daily exercises uptake
HemoHim) increased exercise performance [54]. There among pensioners in Ghana. Despite this, we emphasize
is also the likelihood that pensioners who seek herbal that one major limitation of this study was the cross-sec-
care may have an all-inclusive perspective towards health tional nature of the study which did not allow causal asso-
and wellness, viewing both herbal remedies and physical ciations to be established between the dependent (daily
activity as complementary elements of a healthy lifestyle. exercises uptake) and independent variables (demo-
Conducting qualitative studies could provide an in-depth graphic, socio-economic and lifestyle/health-related
insight into this crucial association. The findings of this variable). We further acknowledge that in terms of the
study further suggest a potential relationship between measurement of the daily exercise uptake, this study did
dissatisfaction with health services and a decreased not clearly highlight the specific forms and durations of
Ongoh et al. Journal of Health, Population and Nutrition (2024) 43:164 Page 10 of 11

Data availability
daily exercises uptake by the participants. Another pos- The datasets used and/or analysed during the current study are available from
sible limitation of this study is that it was conducted in the corresponding author on reasonable request.
one region (Greater Accra) in Ghana. Due to entirely dif-
ferent situations in the various areas of Ghana, the results Declarations
of this study may not reflect the perspective of SSNIT
Ethics approval and consent to participate
pensioners in the other regions of Ghana. The above limi- All procedures performed in this study involving human participants were
tations offer opportunities for future studies to employ in accordance with the ethical standards of the institutional and/or national
longitudinal data to analyze daily exercise uptake among research committee and with the 1964 Helsinki declaration and its later
amendments or comparable ethical standards. Institutional ethics approval
the participants. Building on the findings of this pre- was obtained from the College of Humanities at the University of Ghana,
liminary study in the Ghanaian context, future research Legon (Ref: ECH 006/18–19). Both informed written and verbal consents
could determine the specific forms and durations of daily were obtained from the participants. Participants were assured of strict
confidentiality and anonymity of the data they provided. The participation of
exercise uptake among Ghanaian pensioners across all the respondents in the study was also voluntary.
regions in Ghana.
Consent for publication
Not applicable.
Conclusion
This study examined factors associated with daily exer- Competing interests
cises uptake among SSNIT pensioners in Ghana. The WA-D is a section Editor at Archives of Public Health, BMC. MO, KA-C and EA
declare no conflict of interest.
study found that age, household expenditure, monthly
income, use of medical services by herbalists, joining fit- Author details
1
ness club, satisfaction with sex life and satisfaction with LEAP Management Secretariat, Ministry of Gender, Children and Social
Protection, P.O. Box MB 471, Ministries-Accra, Ghana
health services access/use were statistically significantly 2
School of Social Work, Memorial University of Newfoundland, St. John’s,
associated with uptake of daily exercises among the NL A1C 5S7, Canada
3
participants. The findings of this study provide valuable Agaplesion-Diakonie Klinikum, Elise-Averdieck-Straße 17,
27356 Rotenburg, Germany
insights for policymakers and offer a useful framework 4
Department of Geography and Planning, Queen’s University, Kingston,
for planning and shaping future policies and programs ON K7L 3N6, Canada
aimed at increasing daily exercises uptake among pen-
Received: 17 January 2024 / Accepted: 4 October 2024
sioners in Ghana, and in other geographical contexts
with similar cultural, demographic, and socio-economic
characteristics. These findings further suggest the need
for holistic approaches that consider socio-demographic
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