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      Cost-effectiveness of physical activity programs and services for older adults: a scoping review

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          Abstract

          Background

          Evidence supporting physical activity for older adults is strongly positive. Implementation and scale-up of these interventions need to consider the value for money. This scoping review aimed to assess the volume of (i) systematic review evidence regarding economic evaluations of physical activity interventions, and (ii) of cost utility analysis (CUA) studies (trial- or model-based) of physical activity interventions for older people.

          Methods

          We searched five databases (January 2010 to February 2022) for systematic reviews of economic evaluations, and two databases (1976 to February 2022) for CUA studies of physical activity interventions for any population of people aged 60+ years.

          Results

          We found 12 potential reviews, two of which were eligible for inclusion. The remaining 10 reviews included eligible individual studies that were included in this review. All individual studies from the 12 reviews ( n = 37) investigated the cost-effectiveness of structured exercise and most showed the intervention was more costly but more effective than no intervention. We identified 27 CUA studies: two investigated a physical activity promotion program and the remainder investigated structured exercise. Most interventions (86%) were more costly but more effective, and the remaining were cost-saving compared to no intervention.

          Conclusions

          There is a scarcity of reviews investigating the value for money of physical activity interventions for older adults. Most studies investigated structured exercise. Physical activity interventions were generally more effective than no intervention but more costly. As such an intervention could be cost-effective and therefore worthy of wider implementation, but there is a need for more frequent economic evaluation in this field.

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          Most cited references83

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

            David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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              World Health Organization 2020 guidelines on physical activity and sedentary behaviour

              Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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                Author and article information

                Contributors
                Journal
                Age Ageing
                Age Ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                March 2023
                15 March 2023
                15 March 2023
                : 52
                : 3
                : afad023
                Affiliations
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, Charles Perkins Centre, The University of Sydney , Sydney, Australia
                Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney , Sydney, Australia
                Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney , Sydney, Australia
                Author notes
                Address correspondence to: Marina B. Pinheiro. Tel +61 2 8627 6265. Email: marina.pinheiro@ 123456sydney.edu.au
                Author information
                https://orcid.org/0000-0001-7459-5105
                https://orcid.org/0000-0002-6806-3011
                Article
                afad023
                10.1093/ageing/afad023
                10024893
                36934340
                67839f79-da2f-4f2b-a680-c45885b3c772
                © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 24 March 2022
                : 2 November 2022
                Page count
                Pages: 29
                Funding
                Funded by: University of Sydney Robinson Fellowship;
                Funded by: National Health and Medical Research Council, DOI 10.13039/501100000925;
                Funded by: World Health Organization, DOI 10.13039/100004423;
                Categories
                Systematic Review
                AcademicSubjects/MED00280
                ageing/15

                Geriatric medicine
                physical activity,scoping review,economic evaluation,ageing,older people,systematic review

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