Physical activity interventions for older adults – an overview of systematic reviews

The proportion of people meeting recommended physical activity (PA) guidelines declines with age. Older adults who are physically inactive have an increased risk of: all-cause mortality; chronic diseases; injury and reduced cognitive functioning. Multiple systematic reviews aim to understand the effectiveness of PA interventions but the evidence is fragmented and it is unclear how well the research reflects the needs of older people. We conducted an overview of existing systematic reviews (PROSPERO reference: CRD42015023796) to map evidence on interventions to encourage older people to be more active. Nine electronic databases were searched, most recently in October 2023. Older people were defined as those aged 50+, with physical activity including active daily living (walking the dog, gardening, etc.), organised activities and clubs and more formal exercise or sport. Screening of records, data extraction, and assessments of quality (using AMSTAR-2) and inequality (using Progress-Plus) were completed independently by two reviewers. A total of 35 reviews (reported in 36 papers) published between 2002 and 2023 were included. Reviews included between 3 and 79 studies (total 480 unique studies) with a median of 162 and 184 participants per study in meta-analyses (overall AMSTAR-2 median quality low) and narrative syntheses (median quality critically low) respectively. Eighteen included a mixture of interventions (e.g. supporting lifestyle change, walking groups, exercise classes), nine focussed on remote delivery, six on wearable devices, five on 1-to-1 interventions, two on walking, and two focussed on group-based interventions. Interventions to increase physical activity in older people were shown to be effective in the short term (< 12 months). The use of wearable devices as interventions had a small-to-medium effect on increasing physical activity and daily steps. Remote delivery approaches, including the use of text messaging, web- or mobile-technology, and social media, were effective in increasing PA. A range of interventions are effective in increasing PA in older adults. Newer research highlights the usefulness of technology - including wearable devices, social media, text messaging - as useful tools. Improved effectiveness seems to relate to theory-based interventions, but without further research, caution should be taken when interpreting the effectiveness of individual behaviour change techniques. Identifying and resolving wider barriers and facilitators, social and environmental interactions influencing PA may improve future interventions. Better reporting of equity by future studies will improve understanding of who benefits from such interventions. Increased knowledge of potential wider social, economic and environmental determinants of physical activity in older adults, and specifically more vulnerable and minority populations, will help policy makers and practitioners develop more effective interventions.