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Cochrane Special Collections

Physical activity for healthy ageing

16 April 2021
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Special Collection

First published on 26 November 2020, updated on 16 April 2021 (changes detailed below) 

On 26th November 2020, the World Health Organization (WHO) launched their guidelines on physical activity and sedentary behaviour. This Special Collection curated by the Cochrane Campbell Global Ageing Partnership includes associated relevant topics addressing healthy ageing, aligning with the concerted global action of the Decade of Healthy Ageing (2020 to 2030). The WHO defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”.[1] Functional ability includes people meeting their basic needs, being mobile, continuously learning and growing, building and maintaining relationships, and participating in society.[1]

Older age can be accompanied by a greater risk of developing chronic non-communicable diseases, and associated functional limitations.[2,3] People aged 60 years old and over account for nearly 25% of the disease burden arising from these conditions.[2] However, being free of disease or health conditions is not a requirement for healthy ageing and many older adults have health conditions that can be well managed and therefore have little impact on their quality of life.[1]

Physical activity plays a critical role in promoting healthy ageing, and evidence from epidemiological studies has determined that it is strongly associated with healthier ageing.[5,6] Regular and adequate levels of physical activity have multiple health and wellbeing benefits and can prevent, or even reverse, some effects of chronic conditions across a lifespan.[7] Popular ways to be active are through walking, cycling, dancing, and engaging in hobbies. Any other physical activity that is performed during leisure time, or during work, can have also have health benefits. 

This years’ United Nations International Day of Older Persons focused on how the COVID-19 pandemic affects how ageing is addressed. The impact of quarantine, often in isolation, at home will have a substantial deconditioning effect, affecting millions of older people. Physical inactivity has been shown to be associated with noncommunicable diseases and higher mortality [4], and activity is now more important than ever, given COVID-19 restrictions. 

This Special Collection brings together a selection of Cochrane Reviews assessing the benefits of physical activity interventions on activity levels, physical function, and symptoms. The reviews synthesize evidence regarding the general population, or groups of people who have specific health conditions. A future Special Collection will focus on specific exercise interventions.

You can find more information related to the Decade of Healthy Ageing on the Cochrane Campbell Global Ageing Partnership website, and you can follow the Partnership on Twitter @CCGlobalAgeing 

Updated 16 April 2021: added Cochrane Clinical Answer to the Review 'Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age' 

Promoting physical activity in general populations

Community wide interventions for increasing physical activity

Multi‐strategic community-wide interventions for physical activity are increasingly popular, but their ability to achieve population level improvements is unknown. This review evaluates the effects of community wide, multi‐strategic interventions upon population levels of physical activity. Associated Cochrane Clinical Answer: Do multicomponent community‐wide interventions that include mass media, individual counseling, and organizational partnership components increase physical activity?

Strategies to improve the implementation of workplace‐based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

Workplace‐based interventions can be effective in modifying a range of risk factors, including diet, physical activity, obesity, risky alcohol use, and tobacco use. However, interventions may be poorly implemented, limiting their impact on employee health. This review assesses the effects of strategies for improving the implementation of workplace‐based policies or practices targeting diet, physical activity, obesity, and use of tobacco or alcohol. Associated Cochrane Clinical Answer: What is the effect of implementing workplace‐based health promotion policies and practices?

Targeted mass media interventions promoting healthy behaviours to reduce risk of non‐communicable diseases in adult, ethnic minorities

Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non‐communicable diseases. While mass media interventions are commonly used to encourage healthier behaviours in population groups, it is unclear whether targeted mass media interventions for ethnic minority groups are more effective in changing behaviours than those developed for the general population. This review aims to determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of non‐communicable diseases. Associated Cochrane Clinical Answer: How does the addition of personalized content to mass media interventions impact the behavior of adults from ethnic minority groups residing in the USA?

Participation in environmental enhancement and conservation activities for health and well‐being in adults: a review of quantitative and qualitative evidence

Outdoor environmental enhancement and conservation activities, like unpaid litter picking, tree planting or path maintenance, offer opportunities for physical activity alongside greater connectedness with local environments, enhanced social connections within communities and improved self‐esteem through activities that improve the locality which may, in turn, further improve well‐being. This review assesses the impact of participation in environmental enhancement and conservation activities on health and well‐being in adults. Associated Cochrane Clinical Answer: Can participation in environmental enhancement and conservation activities improve the health and well‐being of adults?

Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age

Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all‐cause and cardiovascular-disease mortality. This review primarily aims to assess the effects of sedentary time of non‐occupational interventions for reducing sedentary behaviour in adults under 60 years of age. Associated Cochrane Clinical Answer: Can interventions outside the workplace for reducing sedentary behavior improve health outcomes for adults under 60 years of age?

Promoting physical activity for chronic conditions

Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment

Vision impairment is associated with a decrease in daily activities. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age‐matched visually normal older people. This review assesses the effectiveness and safety of environmental and behavioural interventions in reducing physical activity limitation, preventing falls and improving quality of life among visually impaired older people. Associated Cochrane Clinical Answers: For older adults with visual impairment, how do environmental and/or behavioral interventions compare? and For older people with visual impairment, how do environmental and behavioral interventions compare with social/home visits?

Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD)

The widely accepted benefits of physical activity, coupled with the increasing availability of wearable monitoring devices to objectively measure participation, has led to a dramatic rise in the number and variety of studies that aimed to improve the physical activity of people with chronic obstructive pulmonary disease (COPD). This review aims to assess which interventions are effective at improving objectively assessed physical activity in people with COPD. Associated Cochrane Clinical Answer: Which interventions lead to increased regular physical activity for people with chronic obstructive pulmonary disease (COPD)?

Physical activity interventions for disease‐related physical and mental health during and following treatment in people with non‐advanced colorectal cancer

Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and that cardiovascular fitness is a strong predictor of all‐cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. This review aims to assess the effectiveness and safety of physical activity interventions on the disease‐related physical and mental health of individuals diagnosed with non‐advanced colorectal cancer. Associated Cochrane Clinical AnswerFor adults with non‐advanced colorectal cancer, what are the effects of physical activity?

Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction

Lower urinary tract symptoms caused by benign prostatic obstruction (LUTS/BPO) is one of the most common clinical complaints in men. Physical activity might represent a viable first‐line intervention for treating LUTS/BPO, and this review assesses the effects of physical activity for LUTS/BPO. Associated Cochrane Clinical Answer: How does physical activity compare with watchful waiting or alpha‐blockers for men with lower urinary tract symptoms secondary to benign prostatic obstruction/hyperplasia?

Activity monitors for increasing physical activity in adult stroke survivors

Physical activity is important for secondary stroke prevention and for promoting functional recovery. However, people with stroke are more inactive than healthy age‐matched controls. Therefore, interventions to increase activity after stroke are vital to reduce stroke‐related disability. This review summarises the available evidence regarding the effectiveness of commercially available, wearable activity monitors and smartphone applications for increasing physical activity levels in people with stroke. Associated Cochrane Clinical Answer: For adult stroke survivors, do activity monitors help increase physical activity?

High‐intensity versus low‐intensity physical activity or exercise in people with hip or knee osteoarthritis

Exercise or physical activity is recommended for improving pain and functional status in people with knee or hip osteoarthritis. It has also been suggested that health benefits may be greater with high‐intensity rather than low‐intensity exercise or physical activity. This review aims to determine the benefits and harms of high‐ versus low‐intensity physical activity or exercise programs in people with hip or knee osteoarthritis. Associated Cochrane Clinical Answer: For people with hip or knee osteoarthritis, how do different physical activity intensities compare?

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Exercise may have specific benefits in reducing the severity of chronic pain, as well as general benefits associated with improved overall physical and mental health, and physical functioning. Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is important to establish the efficacy and safety of these programmes, and this overview of Cochrane Reviews assesses the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use. Associated Cochrane Clinical Answer: What are the effects of physical activity/exercise for adults with chronic pain?

Physical activity for women with breast cancer after adjuvant therapy

Women with a diagnosis of breast cancer may experience short‐ and long‐term disease and treatment‐related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health‐related quality of life, and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. This review assesses the effects of physical activity interventions after adjuvant therapy for women with breast cancer. Associated Cochrane Clinical Answer: What are the benefits and harms of physical activity for women with breast cancer who have received adjuvant therapy?

About this Special Collection

References

1. World Health Organization. Global strategy and action plan on ageing and health. 2017. Available at www.who.int/ageing/global-strategy

2. Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, et al. The burden of disease in older people and implications for health policy and practice. Lancet 2015;385(9967):549-62. https://doi.org/10.1016/S0140-6736(14)61347-7

3. Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age and Ageing 2017;46(6):882-8. https://doi.org/10.1093/ageing/afx150

4. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380(9838):219-29. https://doi.org/10.1016/S0140-6736(12)61031-9

5. Tampubolon G. Trajectories of the healthy ageing phenotype among middle-aged and older Britons, 2004–2013. Maturitas 2016;88:9-15. https://doi.org/10.1016/j.maturitas.2016.03.002

6. Daskalopoulou C, Koukounari A, Wu YT, Terrera GM, Caballero FF, de la Fuente J, et al. Healthy ageing trajectories and lifestyle behaviour: the Mexican health and aging study. Scientific Reports 2019;9:11041. https://doi.org/10.1038/s41598-019-47238-w

7. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 31 May 2013. Geneva;WHO:2013. www.who.int/publications/i/item/9789241506236

Acknowledgements

This Special Collection includes Cochrane Reviews from the following Cochrane Review Groups: Cochrane Airways; Cochrane Breast Cancer; Cochrane Colorectal; Cochrane Eyes and Vision; Cochrane Musculoskeletal; Cochrane Pain, Palliative and Supportive Care; Cochrane Public Health; Cochrane Stroke; and Cochrane Urology. We would like to thank the authors and Review Groups for producing the reviews in this Special Collection.

Monserrat Conde and Tracey Howe of the Cochrane Campbell Global Ageing Partnership produced the introductory text and collated reviews, with support from Monaz Mehta of the Cochrane Editorial & Methods Department.

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