The Role of Health Locus of Control in Walking Time, Hand Grip Strength and Alternate Stepping in a 60-93 Year-Old General Population

Research Article

Austin Aging Res. 2023; 2(1): 1006.

The Role of Health Locus of Control in Walking Time, Hand Grip Strength and Alternate Stepping in a 60-93 Year-Old General Population

Ekström H¹*; Elmståhl S²; Wranker SL²

¹The Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden

²Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Sweden

*Corresponding author: Ekström H Division of Geriatric Medicine, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden. Tel: +46 703 92 86 10; Fax: +46 391313 Email: henrik.ekstrom@med.lu.se

Received: March 13, 2023 Accepted: April 19, 2023 Published: April 26, 2023

Abstract

Individuals with an internal locus of control have been shown to be more self-confident and to perform better in several areas, compared to those with an external locus of control. Few studies have investigated the relationship between Health Locus of Control (HLoC) and physical tests. The aim of this study was to investigate whether and to what extent internal, chance and external HLoC is associated with the outcome of walking speed, hand grip strength and alternate stepping physical tests.

In this cross-sectional study, a total of 3,819 individuals, aged 60-93 years, constituted the study population. Associations between internal, chance and external HLoC and the results from the physical tests were examined in linear regression models, adjusted for sex, age, education, moving-related pain in upper extremities, back and lower extremities, heart disease, lung disease, depressive mood and cognition.

The regression models indicated that a higher result on the internal scale was associated with faster walking, a stronger hand grip and a greater number of steps, while a higher result on the external scale was associated with slower walking, lower hand grip strength and fewer steps.

The findings suggest that in a clinical setting, assessment of HLoC may contribute to the understanding of physical performance in terms of walking speed, grip strength and alternate stepping among adults 60-93 years old. Modification to ensure a stronger internal control has the potential to improve the performance of these physical tests, which could be worth considering in a medical or physiotherapeutic assessment.

Keywords: Health locus of control; Walking speed; Hand grip strength; Alternate stepping; Older adults

Abbreviations: LoC; HLoC; WS; HGS; AS; GåS; SNAC; BMI; MADRS; COPD; MMSE; ICC

Introduction

The theory of a control focus (LoC), introduced by Rotter in 1966 within the framework of Social learning theory [1], describes how an individual's life situation can be partly explained on the basis of an internal or external control locus. That is, either taking responsibility for and acting on one’s own initiative in conjunction with different life events or believing that other people or external forces such as chance are in control or have the greatest influence [2].

Health Locus of Control (HLoC), a control locus set in a health perspective, was first described by Wallston in 1976 [3]. HLoC refers to the extent an individual believes her/his health to be mostly controlled by an internal, chance or external locus. Individuals with an internal HLoC consider that their own responsibility and actions form the basis for their health and well-being, while those with a chance or external locus believe that their health is largely a matter of luck or in the hands of other people such as doctors or healthcare professionals. This means that for those with a chance or external locus, health is something outside of themselves that they cannot influence or control [4].

Many studies have shown the importance of HLoC for general well-being and that health can be affected depending on whether an individual has an internal, chance or external health locus. Internal HLoC has been associated with higher quality of life [5], improved smoking habits [6], better self-rated health [7], maintaining physical function after hospitalization [8], less prone to depressive conditions [9], lower prevalence of cardiovascular diseases [10], greater tolerance of pain [11] and better adherence to anti-hypertensive treatment [12]. Furthermore, individuals with an internal HLoC are more likely to participate in health-promoting activities [13]. This differs from external HLoC, which has been shown to be associated with trust in health professionals [14] and often with a more passive attitude to health problems [15].

Walking Speed (WS), Hand Grip Strength (HGS) and Alternate Stepping (AS) have been used to provide an assessment of health status and functional ability in both healthy individuals and those with impaired health [16-20]. These tests examine several organ systems such as muscles, bones, heart-lung and the nervous system [21,22]. WS and HSG are also employed as criteria in estimating frailty [23].

To the authors’ knowledge, no previous studies have examined the importance of HLoC in relation to WS and HGS among older adults. If HLoC can affect the ability to perform these tests, it would be an important factor to consider both for the physical performance itself and as an essential underlying personal factor in the assessment of physical health, functional ability or frailty. Thus, the aim of this study was to investigate whether and to what extent internal, chance and external HLoC are associated with the outcome of walking speed, hand grip strength and alternate stepping physical tests in a general population aged 60-93 years, adjusted for socio-demographics and health status.

Materials and Methods

Study Population

In this cross-sectional study participants were drawn from the longitudinal Good Aging in Skåne (GÅS) Project, which began in 2001 and is a part of the Swedish National Study on Aging and Care (SNAC). The design of the GÅS and SNAC study is described elsewhere [24,25].

Participants randomized from the national population register were invited to take part in the study by letter and written informed consent was obtained. A total of 6,991 eligible individuals were invited in two waves (Figure 1). From the first wave between 2001 and 2004, 2,931 (60.0%) out of 4,893 agreed to participate, while from the second wave between 2006 and 2012, 1,523 (72.6%) out of 2,098 agreed to participate. The first wave included participants in nine age-cohorts (60, 66, 72, 78, 81, 84, 87, 90 and 93 years) and the second wave participants in two age cohorts (60 and 81 years).