Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis

Abstract

Background: Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults.

Methods: The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10^th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time.

Results: A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively.

Conclusions: In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.

Keywords: Wearable activity trackers; electronic and mobile health; financial incentives; network meta-analysis; older adults; physical activity.

Figure 1.

Flow chart of studies selection.

Figure 2.

Risk of bias graph.

Figure 3.

Risk of bias summary.

Figure 4.

Network plots for studies examining the effectiveness of different interventions in older adults on daily steps, MVPA, sedentary time. CON: control; WAT: wearable activity tracker-based intervention, E&MH: electronic&mobile health intervention, SEP: structured exercise program intervention, FI: financial incentive intervention, WAT + E&MH: wearable activity tracker + electronic and mobile health intervention, WAT + SEP: wearable activity tracker + structured exercise program intervention, FI + WAT: financial incentive + wearable activity tracker intervention, FI + E&MH: financial incentive + electronic and mobile health intervention, E&MH + SEP: electronic and mobile health + structured exercise program intervention, WAT + E&MH + SEP: wearable activity tracker + electronic and mobile health + structured exercise program intervention.