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Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

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Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
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School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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Department of Physical Therapy, Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull University, Padilla 326-332, 08025 Barcelona, Spain
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Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Forbes Tower, 3600 Atwood St, Pittsburgh, PA 15260, USA
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Research group on Methodology, Methods, Models and Outcome of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Sagrada Família 7, 08500 Vic, Spain
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Department of Health Sciences, Faculty of Health Sciences and Welfare, University of Vic, Sagrada Família 7, 08500 Vic, Spain
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Intermediate Care Hospital, Parc Sanitari Pere Virgili, Avinguda de Vallcarca 169-205, 08023 Barcelona, Spain
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RE-FiT Barcelona Research Group, Vall d’Hebrón Institute of Research (VHIR), Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
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Department of Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
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Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Sant Antoni Marià Claret 167, pavilion 18, 08025 Barcelona, Spain
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CIBER Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
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Institute on Health and Aging, Universitat Autònoma de Barcelona (UAB), Sant Antoni Marià Claret 171 (Casa Convalecencia), 08041 Barcelona, Spain
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Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(14), 2527; https://doi.org/10.3390/ijerph16142527
Received: 30 May 2019 / Revised: 12 July 2019 / Accepted: 14 July 2019 / Published: 15 July 2019
(This article belongs to the Special Issue Physical Activity and Healthy Lifestyle)
Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation. View Full-Text
Keywords: Older adults; physical activity; sustainability; adherence; meta-analysis; systematic review Older adults; physical activity; sustainability; adherence; meta-analysis; systematic review
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Sansano-Nadal, O.; Giné-Garriga, M.; Brach, J.S.; Wert, D.M.; Jerez-Roig, J.; Guerra-Balic, M.; Oviedo, G.; Fortuño, J.; Gómara-Toldrà, N.; Soto-Bagaria, L.; Pérez, L.M.; Inzitari, M.; Solà, I.; Martin-Borràs, C.; Roqué, M. Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Int. J. Environ. Res. Public Health 2019, 16, 2527.

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