Systematic review and network meta-analysis on motivational strategies added to physical activity interventions aimed at promoting physical activity among older adults with chronic illnesses.

Abstract

Background: As the aging process of older adults advances, contact between older adults and healthcare professionals intensifies for adopting and maintaining physical activity. Motivational strategies can increase the effectiveness of physical activity interventions on the short- and longer duration. Objective: To investigate the individual effectiveness of motivational interviewing, tailor-made interventions, 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. Data sources: Literature search of PubMed, EMBASE, CINAHL, and PEDro using keywords and subject headings. Study selection: Randomized controlled trials comparing two or more arms, with one arm focused on motivational strategies influencing physical activity were included. 20,690 titles were identified, of which 51 (comprising 11,596 participants) were included. Data extraction: 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 analysis. Results: For primary outcome, 6 months follow-up, pooled data demonstrated higher effectiveness of motivational interviewing interventions, context-related interventions, and interventions using multiple motivational strategies. The quality of the body of evidence was graded as very low for all motivational strategies. Limitations: Data were pooled from a wide variety of different study populations and settings, content of interventions and outcome measures, increasing the heterogeneity of study characteristics. Conclusions: Interventions combining multiple motivational strategies seem to be more effective than using singular treatment strategies, although the optimal composition remains unclear.