What interventions are used to improve exercise adherence in older people and what behavioural techniques are they based on? A systematic review

Abstract

ObjectivesTo conduct a systematic review of interventions used to improve exercise adherence in older people, to assess the effectiveness of these interventions and to evaluate the behavioural change techniques underpinning them using the Behaviour Change Technique Taxonomy (BCTT).DesignSystematic review.MethodsA search was conducted on AMED, BNI, CINAHL, EMBASE, MEDLINE and PsychINFO databases. Randomised controlled trials that used an intervention to aid exercise adherence and an exercise adherence outcome for older people were included. Data were extracted with the use of a preprepared standardised form. Risk of bias was assessed with the Cochrane Collaboration’s tool for assessing risk of bias. Interventions were classified according to the BCTT.ResultsEleven studies were included in the review. Risk of bias was moderate to high. Interventions were classified into the following categories: comparison of behaviour, feedback and monitoring, social support, natural consequences, identity and goals and planning. Four studies reported a positive adherence outcome following their intervention. Three of these interventions were categorised in the feedback and monitoring category. Four studies used behavioural approaches within their study. These were social learning theory, socioemotional selectivity theory, cognitive behavioural therapy and self-efficacy. Seven studies did not report a behavioural approach.ConclusionsInterventions in the feedback and monitoring category showed positive outcomes, although there is insufficient evidence to recommend their use currently. There is need for better reporting, use and the development of theoretically derived interventions in the field of exercise adherence for older people. Robust measures of adherence, in order to adequately test these interventions would also be of use.PROSPERO registration number CRD42015020884.

Which Behavior Change Techniques Are Effective in Promoting Physical Activity Among Older People With Dementia? A Call for Research Into Three Underexplored Avenues

“…Researchers have also predominantly used BCTs that rely on cognitive processes (see Sheeran, Klein, & Rothman, 2017), as shown in a sample of two systematic reviews that have used Michie et al's (2013) taxonomy or similar with older people (French, Olander, Chisholm, & McSharry, 2014) and people with dementia (Nyman et al, 2018; see Supplementary Table S2 [available online]). Similar observations can be drawn from other recently conducted systematic reviews of BCTs used to improve exercise adherence among older people (Room, Hannink, Dawes, & Barker, 2017) and by physiotherapists to promote physical activity (Kunstler et al, 2018). From these systematic reviews, it is evident that the potential for BCTs that do not rely on cognitive processes is relatively underexplored.…”

“…This is in contrast to previous systematic reviews that identified evidence for the use of self-regulatory BCTs with the general adult population to improve diet and physical activity participation (Greaves et al, 2011;Michie, Abraham, Whittington, McAteer, & Gupta, 2009). A recent systematic review also suggests greater potential for self-regulatory BCTs to improve exercise adherence among older people (Room et al, 2017). In addition, as noted previously, a recent systematic review identified potential promise for the use of self-regulatory BCTs to promote physical activity among people with dementia (Nyman et al, 2018).…”

Evaluation of a smartwatch-based intervention providing feedback of daily activity within a research-naive stroke ward: a pilot randomised controlled trial

“…The provision of activity feedback has been found to be more effective in increasing physical activity levels than providing activity goals alone, in healthy controls [ 6 – 8 ] and in older adults undergoing rehabilitation [ 9 ]. Interventions providing feedback and monitoring of activity have shown positive outcomes in relation to exercise adherence amongst older individuals [ 10 ]. However, personalised activity feedback has also found to have no effect on actual or intended activity levels amongst controls [ 11 ].…”

Exercise Maintenance in Older Adults 1 Year After Completion of a Supervised Training Intervention

“…Encouragingly, several studies have reported on factors related to older adults' participation in physical activity or an exercise program . However, most studies have tended to be atheoretical in nature, and this has led to an increased call for the use of theory to underpin and explain exercise interventions . One such theoretical approach is the Theory Domain Framework (TDF) .…”

“…7,8 However, most studies have tended to be atheoretical in nature, and this has led to an increased call for the use of theory to underpin and explain exercise interventions. 9 One such theoretical approach is the Theory Domain Framework (TDF). 10 This framework provides a broad method with which to examine determinants of behavior change, by synthesizing key constructs from 33 behavior change theories into 14 domains.…”