Cambridge Institute of Public Health, Forvie site, Robinson Way, CB2 0SR, Cambridge, United Kingdom.
PLoS One. 2016 Dec 20;11(12):e0168614. doi: 10.1371/journal.pone.0168614. eCollection 2016.
The promotion and maintenance of higher physical activity (PA) levels in the older population is an imperative for cognitive and healthy ageing but it is unclear what approaches are best suited to achieve this for the increasing number of older people living in the community. Effective policies should be informed by robust, multi-disciplinary and multi-dimensional evidence, which not only seeks what works, but in 'what context? In addition to evidence on the efficacy and effectiveness of PA for maintaining cognitive health, social contexts such as 'how do we actually get older people to partake in PA?' and 'how do we sustain that activity long-term?' also need highlighting. This review is part of a comprehensive evidence synthesis of preventive interventions in older age, with a focus on healthy behaviours to identify evidence gaps and inform policy relating to ageing well and cognitive health. An overview of systematic reviews of PA was conducted to explore three topics: (1) PA efficacy or effectiveness for primary prevention of cognitive decline in 55+; (2) Interventions efficacious or effective for increasing PA uptake and maintenance in 55+; (3) barriers and facilitators to PA in 55+.
Multiple databases were searched for studies in English from OECD countries between 2000 and 2016. Quality of included reviews in questions (1) and (2) were assessed using AMSTAR. Review protocols were registered on PROSPERO (CRD42014015554, 42014015584, CRD42014015557) and reviews follow PRISMA guideline.
Overall, 40 systematic reviews were included. Question 1 (n = 14). 8,360 participants. Evidence suggests that PA confer mild positive effects on cognition in older adults with and without previous cognitive impairment. However, there is insufficient evidence of a dose-response relationship. Evidence on the effects of PA on delay of dementia onset is inconclusive. Question 2 (n = 17). 79,650 participants. Evidence supports the effectiveness of a variety of interventions, including group delivered, centre-based and cognitive approaches on short-term uptake of PA behaviour. Question 3 (n = 9). 22,413 participants. Barriers include health status, previous PA habits and experiences, and cultural sensitivity, while facilitators include enjoyable activities and convenient scheduling.
PA can offer small benefits to brain health, but evidence on how much activity is required to produce this effect is lacking. Evidence on the effectiveness of PA for preventing dementia and cognitive decline is lacking. Behavioural (walking, exercise) and cognitive (counselling and motivational interviews) interventions are effective for short-term uptake of physical activity in older people. In order to maintain long-term participation in PA, individualised interventions modelled using behavioural theories may be required. Public health messages should be aimed at promoting acceptable levels of PA above normal daily activities in older people. Policy and strategies aimed at increasing PA in older people should be encouraged while considering barriers and facilitators to behaviour change.
促进和维持老年人更高水平的身体活动（PA）是认知和健康老龄化的必要条件，但目前尚不清楚哪些方法最适合满足不断增加的社区居住老年人的需求。有效的政策应该以强有力的、多学科和多维度的证据为依据，不仅要寻求有效的方法，还要了解“在什么情况下有效？”除了关于 PA 对维持认知健康的功效和有效性的证据外，还需要强调社会背景，例如“我们如何让老年人真正参与 PA？”以及“我们如何长期维持这种活动？”本综述是对老年人群预防干预综合证据综合的一部分，重点关注健康行为，以确定与健康老龄化和认知健康相关的证据差距并为其提供信息。对 PA 的系统评价进行了概述，以探讨三个主题：（1）PA 在预防 55 岁以上人群认知能力下降方面的功效或有效性；（2）增加 55 岁以上人群 PA 参与度和维持率的干预措施的功效或有效性；（3）55 岁以上人群 PA 的障碍和促进因素。
在 2000 年至 2016 年间，在经合组织国家的英语数据库中搜索了这三个主题的研究。使用 AMSTAR 评估了第（1）和第（2）个问题中纳入的综述的质量。综述方案已在 PROSPERO（CRD42014015554、42014015584、CRD42014015557）上注册，综述遵循 PRISMA 指南。
总共纳入了 40 项系统评价。问题 1（n = 14），8360 名参与者。有证据表明，PA 对有和没有先前认知障碍的老年人的认知能力有轻微的积极影响。然而，目前还没有足够的证据表明存在剂量反应关系。PA 对痴呆症发病延迟的影响证据尚无定论。问题 2（n = 17），79650 名参与者。有证据表明，各种干预措施，包括小组、中心和认知方法，对短期 PA 行为的参与度都有效果。问题 3（n = 9），22413 名参与者。障碍包括健康状况、以前的 PA 习惯和经验以及文化敏感性，而促进因素包括愉快的活动和方便的安排。
PA 可以为大脑健康带来小的益处，但缺乏关于需要多少活动才能产生这种效果的证据。PA 预防痴呆和认知能力下降的证据不足。行为（散步、锻炼）和认知（咨询和动机访谈）干预措施对老年人短期 PA 参与度有效。为了保持长期参与 PA，可能需要使用行为理论对个人进行干预。公共卫生信息应旨在促进老年人进行高于日常活动水平的可接受的 PA。应鼓励制定旨在增加老年人 PA 的政策和战略，同时考虑行为改变的障碍和促进因素。
