Physical activity in community-dwelling older people: a review of systematic reviews of interventions and context. (November 2016) - Olanrewaju, Olawale
Abstract: Background: Research evidence on the importance of physical activity for prevention and delay of long-term conditions is strong. However, activity rates decline substantially over the life course, particularly around later life. This review is part of a comprehensive evidence synthesis of preventive interventions in older age, with a focus on healthy behaviours to identify evidence gaps and inform policy relating to ageing well and cognitive health. An overview of systematic reviews of physical activity was conducted to explore in adults aged 55 years and older: (review 1) the effectiveness of physical activity for primary prevention of cognitive decline and dementia; (review 2) interventions effective for increasing physical activity uptake and maintenance; and (review 3) barriers and facilitators to physical activity. Methods: Multiple databases were searched for studies in English from Organisation for Economic Co-operation and Development countries between 2000 and 2014 (Medline, Embase, PsycINFO, CINAHL, Social Science Index, the Cochrane Collaboration and Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and York CRD Database). Search strategy covered the following domains and concepts: ageing and older people; health behaviours and risk reduction relating to diet, physical activity, inactivity, alcohol, smoking; and risk reduction relating to loneliness and isolation, sun exposure, hearing, and vision. The quality of reviews 1 and 2 were assessed with AMSTAR. Findings: 35 systematic reviews were included. In review 1 (12 systematic reviews, 7751 participants), physical activity conferred mild, positive effects on cognition in older adults with and without previous cognitive impairment. However, evidence of a dose–response association was insufficient, and evidence on the effects of physical activity on delay of cognitive decline and dementia onset was inconclusive. The evidence in review 2 (16, 75 194) supported the effectiveness of various interventions, including group-delivered, centre-based, and cognitive approaches on short-term uptake of physical activity behaviour. In review 3 (7, 15 921), barriers included health status, previous physical activity habits and experiences, and cultural sensitivity, whereas facilitators included enjoyable activities and convenient scheduling. Interpretation: Physical activity can offer small benefits to brain health, but evidence on how much activity is required to produce this effect is lacking. Interventions aimed at increasing physical activity in older people should be encouraged while considering barriers and facilitators to behaviour change. In the absence of evidence on the minimum physical activity effective for maintaining brain health and increasing participation, public health messages should be aimed at promoting acceptable levels of physical activity above normal daily activities in older people. To maintain long-term participation in physical activity, individualised interventions modelled using behavioural theories may be required. Funding: National Institute for Health Research (NIHR) School for Public Health Research Ageing Well Programme and the NIHR Collaborations for Leadership in Applied Health Research and Care East of England.