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      Interventions Promoting Physical Activity Among Older Adults: A Systematic Review and Meta-Analysis

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          Abstract

          Background and Objectives

          Frequent participation in physical activity (PA) has benefits across the lifespan but is particularly important for older adults. PA levels are either measured by objective or self-reported survey methods. Objective PA measurement is used to increase accuracy. This systematic review investigated the effect of physical activity-based interventions on objectively measured PA levels among community-dwelling adults aged 60 years and older.

          Research Design and Methods

          Literature searches were conducted in five electronic databases and four clinical trial registries. Randomized controlled trials investigating the effect of physical activity–based interventions on objectively measured PA levels (e.g., accelerometers or pedometers) in community-dwelling adults aged 60 years and older compared with no/minimal intervention were considered eligible. Data were pooled using the most conservative estimates reported from each study using the standardized mean difference (SMD). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the overall quality of the evidence.

          Results

          Fourteen published trials and 3 ongoing trials were identified. There were significant effects favoring physical activity–based interventions compared with minimal intervention at short-term (less than or equal to 3 months) (SMD: 0.30, 95% CI: 0.17 to 0.43) and intermediate-term (more than 3 months and less than 12 months; SMD: 0.27, 95% CI: 0.06 to 0.49) follow-ups. The quality of evidence was moderate according to GRADE (downgraded for risk of bias).

          Discussion and Implications

          Our findings suggest that physical activity–based interventions may increase objectively measured PA levels in community-dwelling older adults. Further studies are still needed to identify the optimal dose, intensity, and mode of delivery of physical activity–based interventions.

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          Most cited references29

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          Interventions for preventing falls in older people living in the community

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            Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses

            Purpose This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. Methods The inclusion criteria specified RCTs with ≥ 12 weeks’ duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. Results We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. Conclusion There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. Trial Registration PROSPERO CRD42015020624 Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0494-y) contains supplementary material, which is available to authorized users.
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              Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories.

              In a meta-analysis we investigated the effect of physical activity with different intensity categories on all-cause mortality. Many studies have reported positive effects of regular physical activity on primary prevention. This recent meta-analysis analyzed all-cause mortality with special reference to intensity categories. A computerized systematic literature search was performed in EMBASE, PUBMED, and MEDLINE data bases (1990-2006) for prospective cohort studies on physical leisure activity. Thirty-eight studies were identified and evaluated. The presentation refers to studies with 3 or 4 different intensities of regular physical activity according to a standard questionnaire. There was a significant association of lower all-cause mortality for active individuals compared with sedentary persons. For studies with three activity categories (mildly, moderately, and highly active) and multivariate-adjusted models, highly active men had a 22% lower risk of all-cause mortality (RR=0.78; 95% CI: 0.72 to 0.84) compared to mildly active men. For women, the relative risk was 0.69 (95% CI: 0.53 to 0.90). We observed similar results in moderately active persons compared to mildly active individuals (RR=0.81 for men and RR=0.76 for women). This association of activity to all-cause mortality was similar and significant in older subjects. Regular physical activity over longer time is strongly associated with a reduction in all-cause mortality in active subjects compared to sedentary persons. There is a dose-response curve especially from sedentary subjects to those with mild and moderate exercise with only a minor additional reduction with further increase in activity level.
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                Author and article information

                Journal
                The Gerontologist
                Oxford University Press (OUP)
                0016-9013
                1758-5341
                December 23 2019
                December 23 2019
                Affiliations
                [1 ]Departamento de Medicina Preventiva e Social, Universidade do Oeste Paulista, Presidente Prudente, Brazil
                [2 ]Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
                [3 ]Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), Brazil
                [4 ]School of Public Health, University of Sydney, Australia
                [5 ]Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
                [6 ]Departamento de Fisioterapia, Centro Universitário UNA, Contagem, Minas Gerais, Brazil
                Article
                10.1093/geront/gnz167
                31868213
                084c038d-c9a2-4e42-b4ce-1ec66413ed42
                © 2019

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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