The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review

Abstract

Background: In an aging population, it is important to activate older adults in taking care of their own health. Increasing physical activity is one way to avoid or lessen age-related physical and mental impairments. Interest in the use of information and communication technology (ICT) tools to promote physical activity among older adults is growing considerably. Such tools are suitable for communicating activation factors-skills, knowledge, and motivation-by integrating a variety of behavior change techniques (BCTs) to enhance physical activity. Although activation factors have been incorporated into physical activity interventions using ICT, little is known about the actual integration methods used in such interventions or about the effects of activation factors on influencing behavior change.

Objective: The first aim of this study was to identify which of the activation factors were covered in physical activity-promoting ICT interventions for older adults and which BCTs were used to address them. The second objective was to classify the user interaction interfaces and delivery modes that were used to promote these activation factors.

Methods: The search engines of PubMed, Web of Science, and ScienceDirect were used to search for and identify articles examining the effectiveness of ICT interventions for promoting physical activity in older adults. References and related data were selected, extracted, and reviewed independently by 2 reviewers. The risk of bias was assessed, and any conflict was addressed by a third separate reviewer. Selected articles included older adults aged ≥55 years without pre-existing medical diseases and other physical or mental conditions that could hinder movement.

Results: In total, 368 records were retrieved, and 13 studies met all inclusion criteria. Articles differed in terms of themes, timescales, user interaction interfaces, and outcome measures; therefore, a quantitative data synthesis was not feasible. Motivation was the most promoted activation factor among all trials (33 times). An app and a smartwatch were used in the majority of intervention groups (7/20, 35%) for tracking physical activity and receiving personalized feedback based on the individual goals. Skills (25 times) and knowledge (17 times) were the next most commonly addressed activation factors. Face-to-face interaction was the most used approach to targeting users' skills, including providing instructions on how to perform a behavior and exchanging knowledge via education on the health consequences of insufficient physical activity. Overall, integrating all 3 activation factors and using multiple user interaction interfaces with a variety of delivery modes proved the most effective in improving physical activity.

Conclusions: This study highlights commonly used BCTs and preferred modes of their delivery. So far, only a limited number of available BCTs (21/102, 21%) have been integrated. Considering their effectiveness, a larger variety of BCTs that address skills, knowledge, and motivation should be exploited in future ICT interventions.

Keywords: activation factors; behavior change techniques; healthy aging; information and communication technology; knowledge; motivation; older adults; physical activity; skills.

Figure 1.. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram.

Figure 2.. User interaction interfaces and delivery modes for delivering activation factors [30-42]. Orange blocks show intervention groups with significant beneficial findings regarding physical activity. Grey blocks highlight the user interfaces used along with the integrated activation factors. A high resolution version of the figure can be found in Multimedia Appendix 3. D: digital; FA: facilitated; H: hybrid; K: knowledge; M: motivation; OB: objective; PE: personalized exercise introduction; S: skills; SU: subjective; SUP: supervised; T: traditional; U: unsupervised.