Physical Activity Interventions Among Older Adults with Chronic Illnesses: Systematic Review and Network Meta-Analysis

To investigate the individual effectiveness of motivational interviewing, tailor-made interventions, social context-related interventions, shared decision making, and monitoring & feedback versus active- and passive control groups on physical activity level among older adults at short-, middle-, and long term. Secondary aim is to compare the effectiveness of interventions using a single motivational strategy versus interventions combining multiple motivational strategies. Literature search of PubMed, EMBASE, CINAHL, and PEDro databases using keywords and subject headings. Randomized controlled trials comparing two or more arms, with one arm focused on motivational strategies influencing physical activity were included. We identified 20,690 titles, of which 51 (comprising 11,596 participants) were included. Methodological quality and quality of evidence was evaluated using PEDro scale and GRADE approach. Outcomes were physical activity levels measured by objective- or subjective instruments at 3-, 6-, and 12 months follow-up. Standardized mean differences between intervention- and control groups were used as the mode of the analyses. For primary outcome, 6 months follow-up, pooled data demonstrated a statistically significant trend for higher effectiveness interventions using multiple motivational strategies compared with an active control intervention, while other singular motivational strategies did not show similar results for this comparison. The quality of the body of evidence was graded as very low for all motivational strategies. In our search, we have used broad in- and exclusion criteria for eligible studies regarding population characteristics resulting in a wide variety of conditions and illnesses included in our review which warrants a better representation of daily clinical practice. However, this led to data being pooled from a wide variety of different study populations and settings, content of interventions and outcome measures, increasing the heterogeneity of study characteristics. Interventions combining multiple motivational strategies show a trend to be more effective than using singular treatment strategies, although the optimal composition remains unclear.