Elsevier

Preventive Medicine

Volume 108, March 2018, Pages 93-110
Preventive Medicine

Review Article
Effectiveness of eHealth interventions for the promotion of physical activity in older adults: A systematic review

https://doi.org/10.1016/j.ypmed.2017.12.026Get rights and content

Highlights

  • Only a minority of older adults meet the recommended physical activity (PA) levels.

  • Our systematic review examined effectiveness of eHealth interventions.

  • eHealth intervention participants were compared to no or non-eHealth intervention.

  • We found that eHealth interventions can effectively promote PA in older adults.

  • Evidence regarding long-term effects of eHealth interventions is still lacking.

Abstract

Regular physical activity (PA) is central to healthy ageing. However, only a minority of older adults currently meet the WHO-recommended PA levels. The aim of this systematic review is to compare the effectiveness of eHealth interventions promoting PA in older adults aged 55 years and above with either no intervention or a non-eHealth intervention (review registration: PROSPERO CRD42015023875). Eight electronic databases were searched to identify experimental and quasi-experimental studies examining the effectiveness of eHealth interventions for PA promotion in adults aged 55 years and above. Two authors independently selected and reviewed references, extracted data, and assessed study quality. In the search, 5771 records were retrieved, 20 studies met all inclusion criteria. Studies varied greatly in intervention mode, content, duration and assessed outcomes. Study quality ranged from poor to moderate. All interventions comprised tailored PA advice and the majority of interventions included goal setting and feedback, as well as PA tracking. Participation in eHealth interventions to promote PA led to increased levels of PA in adults aged 55 years and above when compared to no intervention control groups, at least in the short term. However, the results were inconclusive regarding the question of whether eHealth interventions have a greater impact on PA behavior among older adults than non-eHealth interventions (e.g., print interventions). eHealth interventions can effectively promote PA in older adults aged 55 years and above in the short-term, while evidence regarding long-term effects and the added benefit of eHealth compared to non-eHealth intervention components is still lacking.

Introduction

Regular physical activity (PA) is of central importance to healthy ageing because it is associated with improved physical, functional, psychological, and cognitive health (Warburton et al., 2006, Hong et al., 2008, Hupin et al., 2015). According to the recommendations of the World Health Organization (WHO), older adults should moderately exercise 150 min per week to obtain health benefits. In addition, strength and flexibility training at least two times per week is recommended (WHO, 2010). In the systematic review by Sun and colleagues, the percentages of older adults meeting the recommended PA levels ranged from 2% to 83%. In the majority of studies included in this systematic review, 20% to 60% of older adults met the recommendations (Sun et al., 2013). Sun et al. explain this broad range of older adults meeting the recommendations with discrepancies and inconsistencies in the measurement of various types of PA (including instrumentation) across studies and in the guidelines or recommendations which were also not consistently applied to assess whether individuals met the guidelines or not.

To promote PA in older adults, effective interventions are needed. Interventions providing information on PA in the form of printed materials or face-to-face have a long tradition and appear to be effective for PA promotion in older adults (Noar et al., 2007, Short et al., 2011, Richards et al., 2013). The increased use of the internet and mobile technologies in recent years may open new opportunities to promote PA in adult populations, including older adults (Worldbank, 2013). In the older segments of the general population, a growing number of individuals use electronic devices, such as computers, smartphones or tablets (Smith, 2014). eHealth is defined as “the use of information and communication technologies for health” (WHO, 2015). Potential advantages of eHealth interventions for promoting PA are that information can be accessed easier and quicker by users and that populations can be reached who may not otherwise get into contact with traditional person- or print-based PA interventions (Norman et al., 2007). Results of previous systematic reviews and meta-analyses suggest that eHealth interventions are an effective intervention vehicle for the promotion of PA among adults of various ages (Norman et al., 2007, Krebs et al., 2010, Davies et al., 2012, Foster et al., 2013, Aalbers et al., 2011). However, the evidence for the effectiveness of these interventions in regard to PA promotion among older adults is mixed. Two studies (King et al., 2013a, Silveira et al., 2013) reported increases in participants' activity levels (aged 45–81 years) after receiving an eHealth PA intervention which was delivered by smartphone or tablet. Also, when compared to a no intervention control group, participants aged 55 years and above who received a web-based or telephone-based PA intervention displayed an increase in PA-levels (Irvine et al., 2013, Pinto et al., 2005). On the other hand, Kim and Kang (2006), as well as Peels et al. (2013) could not find an added beneficial effect of eHealth PA interventions compared to non-eHealth interventions in persons aged 55 years and above (i.e., print-delivered intervention, face-to-face intervention). Müller and Khoo (2014) reported that non-face-to-face PA interventions for older adults aged 50 years and above appear to positively affect uptake and maintenance of PA. However, this review did not solely compare eHealth PA interventions to non-eHealth interventions or to no intervention control groups. Hence, the current systematic review aims to compare the effectiveness of eHealth interventions promoting PA in older adults (aged 55 years and above) with either no intervention or a non-eHealth intervention.

Section snippets

Methods

Reporting guidelines of the “Preferred Reporting Items for Systematic Review and Meta-Analyses statement (PRISMA)” are followed for this article (Moher et al., 2009).

Identified studies

In the database search, 5771 records were retrieved. Thirty-nine records were retrieved in the additional search. After screening titles and abstracts (first step) and full-texts (second step), 25 publications of 20 studies were included in this systematic review (Fig. 1).

Study quality

Overall, risk of bias of the included studies was rated as moderate (Pinto et al., 2005, Kim and Glanz, 2013, King et al., 2008, King et al., 2013b, King et al., 2007, Kolt et al., 2007, Thompson et al., 2014, Wijsman et al.,

Discussion

Population-based strategies to promote PA are needed to improve older adults' health and quality of life, in general, and to prevent frailty and the onset or progression of chronic diseases in later stages of life. A promising approach for transporting PA interventions to wider segments of the population is the use of technology to support self-regulatory processes involved in the uptake and maintenance of PA in this population. In this systematic review, we found that eHealth interventions can

Conclusions

To conclude, eHealth interventions can effectively promote PA in older adults aged 55 years and above in the short-term, while evidence for long-term effects is lacking. However, the findings of this systematic review have to be interpreted with caution because studies varied greatly in intervention mode, content, and duration, as well as in the outcomes assessed and the study quality ranged from poor to moderate. Further research is needed to investigate if eHealth interventions are equally,

Abbreviations

    App

    Mobile application

    CENTRAL

    Cochrane Central Register of Controlled Trials

    CG

    Control group

    CINAHL

    Cumulative Index to Nursing & Allied Health Literature

    EMBASE

    Excerpta Medica database

    ES

    Effect size

    IG

    Intervention group

    IPAQ

    International Physical Activity Questionnaire

    PEI

    Physical Education Index

    PA

    Physical activity

    PAR

    Physical Activity Recall

    PDA

    Personal Digital Assistant

    PRISMA

    Preferred Reporting Items for Systematic Reviews and Meta-Analyses

    RCT

    Randomized controlled trial

    SD

    Standard deviation

    WHO

    World

Human and animal rights

Not applicable.

Competing interests

None.

Funding

This systematic review was conducted as part of a dissertation. The research for the dissertation is conducted as part of the “AEQUIPA - Physical activity and health equity: primary prevention for healthy ageing” project, a regional prevention research project and network funded by the German Federal Ministry of Education and Research (grant number: 01EL1422A). The funding agency had no involvement in the execution of this systematic review and the decision to submit the article for publication.

Acknowledgements

We would like to thank our research librarian Lara Christianson (BIPS, Bremen) for providing feedback on the search strategy and the selection of the databases.

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