EVIDENCE ON PHYSICAL ACTIVITY FOR OLDER ADULTS (OVER 64 YEARS OF AGE)

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WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.

WHO Guidelines on Physical Activity and Sedentary Behaviour.

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C1EVIDENCE ON PHYSICAL ACTIVITY FOR OLDER ADULTS (OVER 64 YEARS OF AGE)

Guiding Questions

C1.

What is the association between physical activity and health-related outcomes?

Is there a dose response association (volume, duration, frequency, intensity)?
Does the association vary by type or domain of physical activity?

Inclusion Criteria

Population: Adults over 64 years of age

Exposure: Greater volume, duration, frequency or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcomes	Importance
Falls and fall-related injuries	Critical
Functional ability (e.g., frailty (sarcopenia), balance, strength, mobility, gait speed, activities of daily living)	Critical
Osteoporosis	Critical
Psychosocial outcomes (e.g., social isolation, social participation)	Important

Evidence identified

Twenty-one reviews (published from 2017 to 2019) were initially identified that examined the association between physical activity and health-related outcomes among older adults (1–21). Six reviews were subsequently excluded from further evaluation given the study design, populations, exposures, or outcomes that were out-of-scope. Table C1.1 presents the reviews that were excluded and their reason for exclusion.

In general, these reviews were of moderate quality based on the AMSTAR 2 instrument. One review was rated as having high credibility, 7 were rated as having moderate credibility, 3 were rated as having low credibility, and the remaining 4 reviews were rated as having critically low credibility. Given concerns regarding the comprehensiveness and the validity of the results presented in these reviews, they were not incorporated into the final Evidence Profiles. Table C1.2 presents the ratings for each review according to all the AMSTAR 2 main domains.

Table C1.1Excluded Systematic Reviews, with Reasons for Exclusion

Author, Year	Reason for Exclusion	Rationale
Dillon 2018 (7)	Population	Review limited to older adults with visual impairment
Gordt 2017 (9)	Exposure	Exposure not applicable (wearable sensor balance and gait training)
Hart 2019 (10)	Outcome	Outcome not applicable (health-related quality of life subscale)
Kauppi 2017 (12)	Relevance	Cohort study that addresses the association between social network size (exposure) and levels of health risk behaviours (outcome)
Vancampfort 2019 (20)	Design	Cross-sectional study
Yoshimura 2017 (21)	Population, Exposure	Population limited to adults with sarcopenia; only one included study was an exercise-only intervention

After appropriate exclusions, 2 reviews were included that reported falls-related injuries, 8 reviews were included that reported a measure of physical function (variably defined), and one review was included that measured social support (and was included in the outcome of social isolation) (Table C1.3). Only one review searched for evidence through 2019; several of the reviews only searched through 2014 or 2015. Extracted data for each included review is presented in Appendix A. A link to the summary of the U.S. Physical Activity Guidelines evidence relevant to these subgroups is provided in the Evidence Profiles.

Table C1.2Credibility Ratings (based on AMSTAR 2 (22))

Author, Year	PICO¹	Apriori Methods²	Study Design Selection³	Lit Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assessment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
Binkley 2019 (1)	Y	N	Y	PY	Y	N	PY	PY	PY	N	N/A	N/A	N	N	N/A	N	Critically Low
Bruderer-Hofstetter 2018 (2)	Y	PY	N	PY	Y	Y	PY	Y	PY	N	Y	Y	Y	Y	Y	Y	Moderate
Bueno de Souza 2018 (3)	Y	PY	N	PY	Y	N	PY	Y	Y	N	Y	N	Y	Y	N	Y	Low
Burton 2019 (4)	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	Y	Y	Y	N	Y	Critically Low
da Rosa Orssatto 2019 (5)	Y	PY	N	PY	Y	N	Y	PY	PY	N	Y	N	Y	Y	Y	Y	Moderate
de Souto Barreto 2018 (6)	Y	Y	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	N	Moderate
Falck 2019 (8)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	N	Y	Y	Y	Y	Y	Critically Low
Hita-Contreras 2018 (11)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	N	N	Y	Y	Y	Low
Kidd 2019 (13)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Labott 2019 (14)	Y	PY	N	PY	Y	N	PY	PY	PY	N	Y	Y	Y	Y	Y	Y	Moderate
Lindsay Smith 2017 (15)	Y	PY	N	PY	Y	Y	PY	PY	PY	N	N/A	N/A	Y	N	N/A	Y	Moderate
McMullan 2018 (16)	N	PY	N	PY	Y	Y	Y	PY	Y	N	N	Y	Y	Y	Y	Y	Critically Low
Sherrington 2019 (17)	Y	Y	N	PY	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	High
Sivaramakrishnan 2019 (18)	Y	Y	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Taylor 2018 (19)	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	Y	Y	Y	N	Y	Low

: Abbreviations: COI = conflict of interest; N = no; N/A = not applicable; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
1: Did the research questions and inclusion criteria for the review include the components of PICO?
2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
3: Did the review authors explain their selection of the study designs for inclusion in the review?
4: Did the review authors use a comprehensive literature search strategy?
5: Did the review authors perform study selection in duplicate?
6: Did the review authors perform data extraction in duplicate?
7: Did the review authors provide a list of excluded studies and justify the exclusions?
8: Did the review authors describe the included studies in adequate detail?
9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
10: Did the review authors report on the sources of funding for the studies included in the review?
11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.

Table C1.3Systematic Reviews Assessed, by Author

Author, Year	Outcomes			Last Search Date	# of included studies	AMSTAR 2
Author, Year	Falls-related Injuries	Physical Function	Social Isolation	Last Search Date	# of included studies	AMSTAR 2
Binkley 2019 (1)	✕	✕		Jan 2015	15	Critically Low
Bruderer-Hofstetter 2018 (2)		✕		May 2017	17	Moderate
Bueno de Souza 2018 (3)		✕		Mar 2017	9	Low
Burton 2019 (4)		✕		Aug 2018	18	Critically Low
da Rosa Orssatto 2019 (5)		✕		Jan 2019	14	Moderate
de Souto Barreto 2018 (6)	✕			Mar 2018	40	Moderate
Falck 2019 (8)		✕		Nov 2018	44	Critically Low
Hita-Contreras 2018 (11)		✕		Apr 2018	7	Low
Kidd 2019 (13)		✕		Mar 2017	10	Moderate
Labott 2019 (14)		✕		Dec 2018	24	Moderate
Lindsay Smith 2017 (15)			✕	Aug 2014	27	Moderate
McMullan 2018 (16)		✕		Jul 2016	30	Critically Low
Sherrington 2019 (17)	✕			May 2018	108	High
Sivaramakrishnan 2019 (18)		✕		Sep 2017	16	Moderate
Taylor 2018 (19)		✕		Apr 2015	18	Low

C. Older Adults

C.1. Physical Activity

Table C.1.a. Falls-related Injuries*: Association between physical activity and falls-related injuries among older adults (in alphabetical order by author) (PDF, 105K)

See the Supplementary materials for description of evidence that informed the US PAGAC by outcome

Table C.1.b. Physical Function: Association between physical activity and physical function among older adults (in alphabetical order by author) (PDF, 88K)

See the Supplementary materials for description of evidence that informed the US PAGAC by outcome

Table C.1.c. Social Isolation: Association between physical activity and social isolation among older adults (in alphabetical order by author) (PDF, 63K)

See the Supplementary materials for description of evidence that informed the US PAGAC by outcome

Table C.1.d. Falls prevention (PDF, 102K)

Table C.1.e. Sarcopenia (PDF, 80K)

Appendix A. Data Extractions of Included Reviews

Download PDF (153K)

References

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WHO Guidelines on Physical Activity and Sedentary Behaviour.

C1EVIDENCE ON PHYSICAL ACTIVITY FOR OLDER ADULTS (OVER 64 YEARS OF AGE)

Guiding Questions

Inclusion Criteria

Evidence identified

Table C1.1Excluded Systematic Reviews, with Reasons for Exclusion

Table C1.2Credibility Ratings (based on AMSTAR 2 (22))

Table C1.3Systematic Reviews Assessed, by Author

C. Older Adults

C.1. Physical Activity

Appendix A. Data Extractions of Included Reviews

References

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