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Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis.

ABSTRACT: INTRODUCTION:Physical activity (PA) is an important aspect for health and well-being, yet many older adults do not maintain their PA long term. The identification of key factors that are associated with, and likely causally related to, older adults' PA maintenance is a crucial first step towards developing programmes that are effective at promoting long-term PA behaviour change. The purpose of this protocol is to outline a systematic review that will examine the relationship between four motives (ie, satisfaction, enjoyment, self-determination and identity) and older adults' PA maintenance. METHODS AND ANALYSIS:Studies that investigated PA maintenance with a sample mean age ?55 years will be included. Five electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, PsycINFO and ProQuest Dissertations and Theses) were searched on 6 April 2018 with no publication date limit (ie, from inception). One reviewer screened 100% of titles and abstracts (k=21?470) while a random subsample (20%) was screened independently by two reviewers. An update of the search was run on 1 October 2019. All studies for which the full text was retrieved will be independently screened by two reviewers. Data pertaining to study sample, design, motives, PA (eg, measurement validity evidence, study definition of maintenance) and essential bias domains (eg, bias due to missing data) will be extracted. Study-level effect sizes will be calculated, and if the number of studies is ?5, a random-effects meta-analysis will be performed using inverse-variance methods; a narrative synthesis will be performed otherwise. ETHICS AND DISSEMINATION:The university's Human Research Protection Program determined that the proposed study qualifies as exempt from the Institutional Review Board review under Exemption Category 4 (PROPEL #: 80047007). Results will be published in a peer-review journal, and the findings will help inform future interventions with older adults. PROSPERO REGISTRATION NUMBER:CRD42018088161.

SUBMITTER: Huffman MK

PROVIDER: S-EPMC7044937 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis.

Huffman Mary Katherine MK Reed Jason Brian JB Carpenter Theresa T Amireault Steve S

BMJ open 20200213 2

<h4>Introduction</h4>Physical activity (PA) is an important aspect for health and well-being, yet many older adults do not maintain their PA long term. The identification of key factors that are associated with, and likely causally related to, older adults' PA maintenance is a crucial first step towards developing programmes that are effective at promoting long-term PA behaviour change. The purpose of this protocol is to outline a systematic review that will examine the relationship between four ...[more]

PMID: 32060153

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Project description:Background:The body of evidence related to the effect of physical activity monitor-based interventions has grown over the recent years. However, the effect of physical activity monitor-based interventions in older adults remains unclear and should be systematically reviewed. Objective:The objective of this systematic review was to estimate the effect of physical activity monitor-based interventions on physical activity behavior in participants aged 65 and above. Subsequently we explored the effect on body mass index, physical capacity, and health-related quality of life and finally the impact of patient- and intervention characteristics. Methods:Searches in MEDLINE, EMBASE, SPORTDiscus, CINAHL, and CENTRAL were performed on April 26, 2018. No publication date filters were applied. References of eligible studies were scrutinized and relevant journals were hand-searched. Randomized controlled trials and randomized cross-over trials investigating the effect of a physical activity monitor-based intervention on physical activity were included. Studies were included if the mean age of the participants was above 65?years, and participants could walk independently with or without walking aids. The Cochrane handbook was used as a template for extracting data and the RoB 2.0 tool was used to assess risk of bias. Random-effects meta-analysis using Hedges g, were used to pool the study results. The main outcome of this study was physical activity. Results:Twenty-one studies with 2783 participants were included. The median participant age in the studies was 70.5?years, the median percentage of male participants was 42%, and the median baseline daily step count was 5268. Physical activity monitor-based interventions had a moderate effect (SMD?=?0.54, 95% CI: 0.34 to 0.73) compared to control interventions, corresponding to an average increase of 1297 steps per day in the intervention groups. No impact of patient and intervention characteristics on the effect estimates were found. Short conclusion:Low quality of evidence was found for a moderate effect of physical activity monitor-based interventions on physical activity compared with control interventions. More studies with higher research methodology standards are required. PROSPERO registration:CRD42018083648.

Project description:ImportancePhysical activity is associated with the risk for cognitive decline, but much of the evidence in this domain comes from studies with short follow-ups, which is prone to reverse causation bias.ObjectiveTo examine how length of follow-up, baseline age, physical activity amount, and study quality modify the longitudinal associations of physical activity with cognition.Data sourcesObservational studies of adults with a prospective follow-up of at least 1 year, a valid baseline cognitive measure or midlife cohort, and an estimate of the association of baseline physical activity and follow-up cognition were sought from PsycInfo, Scopus, CINAHL, Web of Science, SPORTDiscus, and PubMed, with the final search conducted on November 2, 2022.Study selectionTwo independent researchers screened titles with abstracts and full-text reports.Data extraction and synthesisTwo reviewers independently assessed study quality and extracted data. Pooled estimates of association were calculated with random-effects meta-analyses. An extensive set of moderators, funnel plots, and scatter plots of physical activity amount were examined. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.Main outcomes and measuresPooled estimates of the associations between physical activity and global cognition, as well as specific cognitive domains, were examined.ResultsA total of 104 studies with 341 471 participants were assessed. Analysis of binary outcomes included 45 studies with 102 452 individuals, analysis of follow-up global cognition included 14 studies with 41 045 individuals, and analysis of change in global cognition included 25 studies with 67 463 individuals. Physical activity was associated with a decreased incidence of cognitive impairment or decline after correction for funnel plot asymmetry (pooled risk ratio, 0.97; 95% CI, 0.97-0.99), but there was no significant association in follow-ups longer than 10 years. Physical activity was associated with follow-up global cognition (standardized regression coefficient, 0.03; 95% CI, 0.02-0.03) and change in global cognition (standardized regression coefficient, 0.01; 95% CI, 0.01 to 0.02) from trim-and-fill analyses, with no clear dose-response or moderation by follow-up length, baseline age, study quality or adjustment for baseline cognition. The specific cognitive domains associated with physical activity were episodic memory (standardized regression coefficient, 0.03; 95% CI, 0.02-0.04) and verbal fluency (standardized regression coefficient, 0.05; 95% CI, 0.03-0.08).Conclusions and relevanceIn this meta-analysis of the association of physical activity with cognitive decline, physical activity was associated with better late-life cognition, but the association was weak. However, even a weak association is important from a population health perspective.

Project description:BACKGROUND: The purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence. METHODS: Prospective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed. RESULTS: Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices. CONCLUSIONS: There is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.

Project description:BackgroundIncreasing physical activity in older adults remains a key public health priority in countries with a high burden of non-communicable disease, yet current interventions have failed to substantially increase population uptake with UK data suggesting that only half of 65-74 year olds report meeting recommended levels. The aim of this study was to conduct a systematic and inductive qualitative synthesis of the large body of qualitative research describing what influences physical activity at this age, and older adults' experiences of physical activity.MethodsA qualitative meta-ethnography was chosen as the study design as this inductive approach can provide novel insights and generate new theory about physical activity and ageing. Papers were identified by searching electronic databases and key citations. Peer-reviewed primary qualitative studies and systematic reviews were included if they met the following inclusion criteria: community-dwelling participants aged 60 years or older or in the retirement transition period; reporting on leisure-time physical activity; utilising a rigorous qualitative methodology. A line of argument approach was employed to generate a theory about how older adults think and feel about physical activity.ResultsThirty-nine papers met the inclusion criteria and were synthesised. The emergent theory suggested transition to older age can challenge people's sense of self and their role in life. Physical activity can help in regaining feelings of purpose, of being needed in collective group activity, and by creating habitual routine and structure to the day. In overcoming real and perceived barriers, and by taking up or sustaining physical activities, older adults can further build self-esteem all of which contributes to a fulfilling older age.ConclusionCurrent failures to increase population levels of physical activity in older adults may be explained by an approach overly focused on the health benefits of activity. Insights from this study suggest we need to reframe our approach to consider the wider set of goals and aspirations which are of greater personal importance to older adults, and future interventions should focus on how physical activity can contribute to life satisfaction, sense of purpose, and sense of role fulfilment in older age.Trial registrationRegistered prospectively on PROSPERO on 29th March 2013: CRD42013003796 .

Project description:BACKGROUND:Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (?65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement. METHODS:One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined. RESULTS:Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found. CONCLUSIONS:Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ?5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.

Project description:Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (?65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs.We will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important.This review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review.PROSPERO CRD42014014989.

Dataset Information

Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis.

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Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis.

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