PHYSICAL ACTIVITY TECHNOLOGY-MEDIATED INTERVENTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS ON ITS IMPACT ON OLDER ADULTS COGNITIVE AND PHYSICAL FUNCTIONING

P. Stefane^1,2,3, O. Ribeiro^1,2, V. Afreixo^4,5, A.G. Silva^1,6

¹Center for Health Technology and Services Research (CINTESIS@RISE), Aveiro, Portugal, ²University of Aveiro, Department of Education and Psychology, Aveiro, Portugal, ³University of Porto, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal, ⁴Center for Research & Development in Mathematics and Applications (CIDMA), Aveiro, Portugal, ⁵University of Aveiro, Department of Mathematics, Aveiro, Portugal, ⁶University of Aveiro, School of Health Sciences, Aveiro, Portugal

Background: Mild cognitive impairment (MCI) is defined as an early stage of cognitive decline with a risk of progressing to dementia. The number of people living with dementia worldwide is expected to continue increasing for the next decades. Therefore, identifying interventions able to prevent MCI as well as to delay its progression is of uttermost relevance. Research has suggested that physical activity and cognitive training play an important role in preventing cognitive decline and technology-mediated physical activity is believed to require both physical and cognitive abilities. Furthermore, it has the potential to contribute to provide cognitive and physical activity training to a larger number of persons at lower costs than traditional face-to-face cognitive and physical activity interventions.

Purpose: This study aims to assess existing evidence on the effectiveness of technology-mediated physical activity on both physical and cognitive function of older adults.

Methods: The protocol of this systematic review and meta-analysis was previously registered in Prospero (CRD42020170796). Four databases (PubMed, SCOPUS, SciELO and Web of Science) were searched since inception using a combination of words related to physical activity, technology, and older adults. We included studies published in English, Portuguese, and Spanish languages, randomized or quasi-randomized clinical trials, including participants with 55 years or older with no to mild cognitive impairment. Risk of bias and quality of evidence were assessed using Rob 2 and GRADE, respectively. A meta-analysis was performed using R packages meta and metafor. To perform the meta-analysis, studies were sub-grouped into (i)healthy older adults and (ii)older adults with clinical conditions. Within each of these two groups, studies were further sub-grouped for physical function into five domains (general functional mobility, lower limb functional mobility, balance, endurance of lower limbs, endurance/strength of upper limbs), and for cognitive function into eight domains (general cognition, immediate verbal memory, delayed verbal memory, working memory, processing speed, attention, inhibition, short-term memory).

Results: Thirty-two studies were included (19 with healthy older adults and 13 with older adults with clinical conditions). Meta-analysis results suggest that physical activity technology-mediated interventions are superior to normal daily activities for general functional mobility (SMD 0.43,95% CI 0.11 – 0.76,p=0.04;I²= 33%,p=0.20), lower limb functional mobility (SMD 0.32,95% CI 0.10 – 0.55,p=0.81;I²= 0%,p=0.70), and attention (SMD 0.53,95% CI 0.11 – 0.95,p<0.01,I²= 0%,p=0.77) in healthy older adults. In addition, it has similar effects to face-to-face exercise/physical activity for the remaining physical and cognitive domains in healthy older adults and in older adults with clinical conditions (p>0.05 for all sub-group analysis).

Conclusions: Physical activity technology-mediated interventions seem to impact physical and cognitive functioning of older adults at least to an extent similar to traditional physical activity/exercise and be superior to normal daily activities for general functional mobility, lower limb functional mobility and attention in healthy older adults.

Implications: Findings open possibility of using technology to increase the number of older adults that can be reached by physiotherapy services and suggest that both technology-mediated physical activity and traditional physical activity interventions can be used interchangeably, depending on participants and physiotherapists context and preferences. However, results should be interpreted with caution due to study heterogeneity.

Funding acknowledgements: This work was supported by the national funds through FCT, I.P., within CINTESIS R&D Unit (UI/BD/151503/2021)

Keywords:
Technology
Older adults
Physical activity

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Older people

Did this work require ethics approval? No

Reason: It is a systematic review and meta-analysis ​