Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Sansano-Nadal Sansano-Nadal,Pérez Pérez,Martin-Borràs Martin-Borràs,Inzitari Inzitari,Giné-Garriga Giné-Garriga,Roqué Roqué,Jerez-Roig Jerez-Roig,Soto-Bagaria Soto-Bagaria,Fortuño Fortuño,Gómara-Toldrà Gómara-Toldrà,Brach Brach,Oviedo Oviedo,Wert Wert,Guerra-Balic Guerra-Balic,Solà Solà

doi:10.3390/ijerph16142527

Abstract

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

Highlights

Many health-oriented systems and organizations are faced with the challenge of implementing new health-related practices, and while many of these programs demonstrate initial success, they fail to become a habit or routine for the participants
Physical activity (PA) is a major aspect of chronic disease self-management [7,8,9,10,11,12,13], and higher levels of PA are associated with healthy ageing [14]
The 12 studies that were included in the final analyses investigated a total of 18 exercise-based arms [34,35,36,37,38,39,41,42,43,44,45,48], compared to four active control groups [34,36,42,44] and nine non-active control groups [35,37,38,39,41,43,45,48]

Summary

Introduction

Many health-oriented systems and organizations are faced with the challenge of implementing new health-related practices, and while many of these programs demonstrate initial success, they fail to become a habit or routine for the participants. Greenhalgh et al [1] pointed out there was a near absence of studies focusing primarily on how to sustain health promotion interventions in the long term. While intervention sustainability is defined as the continued use of intervention components and activities for the continued achievement of desirable health outcomes within the population of interest [2], determining how to foster the maintenance of health-related benefits acquired by the intervention’s recipients once it ends is another great challenge [3]. Physical activity (PA) is a major aspect of chronic disease self-management [7,8,9,10,11,12,13], and higher levels of PA are associated with healthy ageing [14]. The road towards sustainable maintenance to PA might be the cornerstone of health promotion

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