Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
Syst Rev. 2022 Apr 29;11(1):80. doi: 10.1186/s13643-022-01966-9.
Prescribed exercise to treat medical conditions and to prepare for surgery is a promising intervention to prevent adverse health outcomes for older adults; however, adherence to exercise programs may be low. Our objective was to identify and grade the quality of predictors of adherence to prescribed exercise in older adults.
Prospective observational and experimental studies were identified using a peer-reviewed search strategy applied to MEDLINE, EMBASE, Cochrane, and CINAHL from inception until October 6, 2020. Following an independent and duplicate review of titles, abstracts, and full texts, we included prospective studies with an average population age >65 years, where exercise was formally prescribed for a medical or surgical condition. We excluded studies where exercise was prescribed for a chronic musculoskeletal condition. Risk of bias was assessed using the Quality in Prognostic studies tool or Cochrane risk of bias tool, as appropriate. Predictors of adherence were identified and graded for quality using an adaptation of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies.
We included 19 observational studies and 4 randomized controlled trials (n=5785) Indications for exercise included cardiac (n=6), pulmonary rehabilitation (n=7), or other (n=10; surgical, medical, and neurologic). Of the 10 studies that reported adherence as the percent of prescribed sessions completed, average adherence was 80% (range 60-98%; standard deviation (SD) 11%). Of the 10 studies that reported adherence as a categorical threshold demarking adherent vs not adherent, average adherence was 57.5% (range 21-83%; SD 21%). Moderate-quality evidence suggested that positive predictors of adherence were self-efficacy and good self-rated mental health; negative predictors were depression (high quality) and distance from the exercise facility. Moderate-quality evidence suggested that comorbidity and age were not predictive of adherence.
These findings can inform the design of future exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed exercise.
PROSPERO CRD42018108242.
针对医疗状况和手术准备进行规定的运动是一种预防老年人不良健康后果的很有前途的干预措施；然而，对运动方案的坚持可能很低。我们的目的是确定和分级预测老年人对规定运动的坚持的质量。
使用经过同行评审的搜索策略，从 MEDLINE、EMBASE、Cochrane 和 CINAHL 中识别和分级了前瞻性观察性和实验性研究，该策略从成立到 2020 年 10 月 6 日一直适用。经过对标题、摘要和全文的独立和重复审查，我们纳入了平均人群年龄＞65 岁的前瞻性研究，其中针对医疗或手术状况正式规定了运动。我们排除了运动是为慢性肌肉骨骼疾病规定的研究。使用适当的预后研究工具或 Cochrane 风险偏倚工具评估了风险偏倚。使用预测研究的 Grading of Recommendations Assessment, Development, and Evaluation (GRADE)框架的改编版，确定和分级了坚持的预测因素。
我们纳入了 19 项观察性研究和 4 项随机对照试验（n=5785）。运动的适应证包括心脏（n=6）、肺康复（n=7）或其他（n=10；手术、医疗和神经）。在报告了以完成规定的疗程百分比表示的坚持率的 10 项研究中，平均坚持率为 80%（范围 60-98%；标准差（SD）11%）。在报告了以区分坚持者和非坚持者的规定阈值表示的坚持率的 10 项研究中，平均坚持率为 57.5%（范围 21-83%；SD 21%）。中等质量证据表明，坚持的积极预测因素是自我效能和良好的自我评估心理健康；消极预测因素是抑郁（高质量）和距离运动设施的远近。中等质量证据表明，合并症和年龄与坚持无关。
这些发现可以为未来的运动方案设计以及识别可能需要额外支持以从规定运动中受益的个体提供信息。
PROSPERO CRD42018108242。
