Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

Abstract

Background To improve older patients’ physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs). Methods In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000–May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels. Results The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients’ fear, and HCPs’ safety concerns; interpersonal level: patient-HCP relation and HCPs’ unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients’ unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators. Conclusion The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.

Perceived barriers and facilitators of childcare providers’ physical activity: A mixed-methods study

“…Including opportunities for, and encouraging providers to seek, social support may be crucial for improving childcare providers’ movement behaviours (Booth et al, 2000). To further promote PA, it may be important to increase the availability of resources such as at-home exercise equipment and raise awareness about pleasant local natural environments (Dijkstra et al, 2022; Tuso, 2015). In addition, utilising the conceptual model of early childhood teacher well-being developed by Kwon et al (2022; which draws attention to importance of physical, psychological, and professional well-being) could help us to identify other areas of well-being that could be targeted to improve overall well-being.…”

Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis

“…According to SEM, behavior is influenced by individual (e.g., knowledge, attitudes, self-efficacy), social (e.g., social norms, family, peers), and environmental factors (e.g., family environment, community, public policy) [ 26 ]. It has become a useful tool for exploring factors associated with dietary or exercise adherence in different populations [ 27 , 28 ].…”

Implementation, Feasibility, and Acceptability of MATCH to Prevent Iatrogenic Disability in Hospitalized Older Adults: A Question of Geriatric Care Program?

“…Despite the well-established health benefits of PA, it still needs to be fully integrated into usual care (real-life settings), including various geriatric care units. Barriers to promoting PA as routine care for hospitalized older adults include (1) clinicians’ attitude and awareness (ageism, behaviour) and lack of knowledge; (2) patients’ level of fitness (intrapersonal level); (3) safety concerns; (4) lack of space and resources (including time or equipment; institutional level); and (5) the need for well-defined PA protocols [ 16 ]. Thus, to counteract these barriers, geriatric clinicians (MDs, nurses, kinesiologists, or physiotherapists) and researchers in gerontology collaborated to establish a pragmatic exercise intervention known as MATCH (Maintenance of AuTonomy through exerCise during Hospitalization) using a co-creation design to implement PA as usual care during hospitalization.…”