Interventions simultaneously promoting social participation and physical activity in community living older adults: A systematic review

Social network characteristics associated with mid-to-older aged adults' co-engagement in physical activity

OBJECTIVES

Physical activity is associated with a greater quantity and quality of social connections. Participating in physical activity with others (co-engagement) has dual physical and social benefits that can promote healthy ageing. We aimed to understand the social network characteristics of mid-to-older aged adults associated with co-engagement in physical activity.

METHODS

Adults aged 55-75 years completed a social network survey (3679 social contacts reported by 140 participants). Multilevel modelling was used to identify the characteristics of participants, social contacts, and relationships that were predictive of co-engagement in physical activity.

RESULTS

Network size and relationship quality were not associated with co-engagement. Similarity in age, greater interaction frequency, closer geographic proximity, and shorter relationship length were associated with higher odds of co-engagement.

DISCUSSION

For co-engagement, the quality and quantity of relationships were less important than the convenience and accessibility of relationships, particularly newer relationships. As such, co-engagement ties can be understood as part of a dynamic social convoy which fulfil a specific function at a specific life stage. An understanding of naturally occurring tendencies for co-engagement may be utilised to identify leverage points for the development of interventions.

Bidirectional relationships between physical exercise and depressive symptoms among Chinese older adults evidence from the China family panel studies

The study aimed to explore the bidirectional causal relationship between physical activity and depressive symptoms in older adults using a multi-wave follow-up design, expanding on established evidence of a bidirectional relationship between physical activity and depression in older adults. Drawing on individual-level tracking data from the China Family Panel Studies (2016, 2018, and 2020), the causal relationship was tested using fixed effects and cross-lagged panel models. Results indicated that physical exercise was a significant negative predictor of depression in older adults across both continuous (β=-0.056, p < 0.001) and categorical variables (β=-0.536, p < 0.001). After controlling for unobserved confounders, physical exercise continued to have a significant negative impact on depressive symptoms (β=-0.024, p < 0.05; β=- 0.210, p < 0.05). Cross-lagged analyses revealed that physical exercise significantly influenced depressive symptoms only during the T1→T2 phase (β=-0.073, p < 0.001), while depressive symptoms negatively predicted physical activity in later phases (β=-0.068, p < 0.001; β=-0.082, p < 0.001). This finding underscores that while physical exercise can positively impact depressive symptoms in older adults, it may not be sufficient during public health crises or social emergencies. A holistic approach, incorporating social support and psychological interventions, is essential for more effective prevention and management of depressive symptoms.

Multihealth Promotion Programs on Physical Health and Quality of Life in Older Adults: Quasi-Experimental Study

BACKGROUND

Physical activity and appropriate nutrition are essential for older adults. Improving physical health and quality of life can lead to healthy aging.

OBJECTIVE

This study aims to investigate the long-term effects of multihealth promotion programs on the physical and mental health of older adults in communities.

METHODS

A quasi-experimental method was used to recruit 112 older adults voluntarily from a pharmacy in central Taiwan between April 2021 and February 2023. Participants were divided into an experimental group receiving a multihealth promotion program and a control group with no specific intervention. The study measured frailty, nutritional status, well-being, and quality of life using standardized tools such as the Clinical Frailty Scale (CFS), Mini-Nutritional Assessment-Short Form (MNA-SF), Well-being Scale for Elders, and the EQ-5D-3L. Data were analyzed using descriptive statistics, independent t tests, Pearson correlation, and generalized estimating equations.

RESULTS

A total of 112 participants were recruited. There were 64 (57.1%) in the experimental group and 48 (42.9%) in the control group. The experimental group exhibited significantly better quality of life (EQ-5D index) at weeks 12 (β=-.59; P=.01) and 24 (β=-.44; P=.04) compared to the control group. The experimental group muscle mass significantly increased at weeks 24 (β=4.29; P<.01) and 36 (β=3.03; P=.01). Upper limb strength improved significantly at weeks 12 (β=3.4; P=.04) and 36 (β=5; P=.01), while core strength showed significant gains at weeks 12 (β=4.43; P=.01) and 36 (β=6.99; P<.01). Lower limb strength increased significantly only at week 12 (β=4.15; P=.01). Overall physical performance improved significantly at weeks 12 (β=5.47; P<.01), 24 (β=5.17; P<.01), and 36 (β=8.79; P<.01).

CONCLUSIONS

The study's findings highlight the practical benefits of interventions, including physical and social activities and nutritional support, in enhancing the quality of life and general physical health of older adults. This study's findings have significant implications for clinical practice. These findings can aid in the establishment of effective interventions for older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05412251; https://clinicaltrials.gov/study/NCT05412251.

Causal mediation of the association between educational attainment and late-life cognitive function by trajectories of social participation

BACKGROUND

Education is a well-established predictor for late-life cognition. Moreover, social participation is associated with late-life cognition and could mediate the association between education and cognitive function. Yet, few studies have formally tested this question within a causal mediation framework.

METHODS

We used data from the Taiwan Longitudinal Study in Aging. Participants were aged 50 or above and recruited in 1989 (n = 4,400), stratified by age group (aged 50-64 years versus 65 or above). We used sequence analysis and optimal matching techniques to define clustered patterns of social participation and work trajectories. We then used a four-way decomposition to identify causal mediation of the association between educational attainment and cognitive function by social participation. Cognitive function was measured by the Short Portable Mental Status Questionnaire.

RESULTS

The mediating pathway through social participation accounted for 5% or less of the total relation of education on late-life cognitive function for both younger and older subgroups. The interaction between education and social participation accounted for 22% (middle/high school) and 34% (college+) of the total effect, contrasting with no formal education. We estimated that 36% (95% C.I. = 0.09, 0.69) of the educational disparity in late-life cognition among the younger cohort could be eliminated if the least educated group's social participation matched that of the college or above group. Social participation was not a significant mediator in the older subgroup.

CONCLUSION

To mitigate educational disparities in late-life cognitive function, further exploration of encouraging more active social participation or stable employment should be undertaken.

The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review

BACKGROUND

The rapidly emerging integration of both technological applications and environmental factors in physical activity (PA) interventions among older adults highlights the need for an overarching investigation.

OBJECTIVE

This scoping review compiled the current literature and aimed to provide an overview of the role of physical, social, socioeconomic, and systemic environmental factors in technology-assisted PA interventions for older adults.

METHODS

We systematically searched 6 common databases up to September 16, 2024, for original longitudinal studies (with at least one preintervention measurement and one postintervention measurement) that reported on the role of environmental factors in technology-assisted PA interventions for independently living, community-dwelling older adults. In a stepwise process, data on study characteristics (step 1), environmental factors and their role in the included studies (step 2), and intervention outcomes and effects by type of environmental factor (step 3) were summarized.

RESULTS

A total of 8020 articles were screened, and 25 (0.31%) were included. Most studies were conducted in Europe (11/25, 44%), followed by North America (5/25, 20%), Asia (5/25, 20%), and Oceania (4/25, 16%). Social environmental factors were most often considered (19/25, 76%), followed by factors from the physical (8/25, 32%), socioeconomic (1/25, 4%), and systemic environment (1/25, 4%). Environmental factors were used as the outcome (8/25, 32%), setting variable (7/25, 28%), moderator or facilitator (8/25, 32%), and intervention component (3/25, 12%). In most studies (19/25, 76%), the intervention had a beneficial effect on the outcome of interest, and the included environmental factor played a supportive role in achieving this effect. In some studies, no effect (3/25, 12%), mixed effects (2/25, 8%), or adverse effects (1/25, 4%) of the interventions were reported.

CONCLUSIONS

This is the first comprehensive description of how environmental factors interact with technology-assisted interventions to increase or optimize PA in older adults. It was found that the investigation of environmental factors in this field is at an early stage. Environmental factors were found to play a supportive role in achieving beneficial effects of technology-assisted PA interventions, but the findings were based on a heterogeneous empirical platform. Still, certain aspects such as the application of virtual reality environments and social (or peer) comparison have shown significant potential that remains to be leveraged. A better understanding of intervention results and support in tailoring intervention programs can be provided through the inclusion of environmental aspects in technology-assisted PA interventions for older adults.

Protocol for an intergenerational randomized controlled trial to enhance physical activity in older adults at risk for Alzheimer's disease

BACKGROUND

Physical inactivity is one of the most important modifiable risk factors for Alzheimer's disease in North America. Despite this, most older adults are physically inactive. It is currently unknown how to successfully motivate physical activity behavior in older adults at risk for Alzheimer's disease, and this knowledge is crucial for early and effective disease prevention. Prior research has shown that intergenerational social engagement and prosocial behaviours can enhance the health and well-being of older adults.

OBJECTIVES

This manuscript describes the design of a randomized controlled trial that will test the efficacy of a behavioral intervention to enhance physical activity in older adults at risk for Alzheimer's disease.

DESIGN/SETTING

This is a single-blinded, two-arm stratified randomized controlled trial that incorporates a hybrid efficacy and implementation design. Participants are randomized to an intervention or control condition in a 1:1 ratio and are stratified by a multimodal Alzheimer's disease risk score. All study visits are conducted remotely through videoconferencing.

PARTICIPANTS

The study aims to recruit 60 older adults with a first-degree family history of Alzheimer's disease from the PREVENT-AD cohort and 30 younger adults who are paired with older adults in the intervention condition.

INTERVENTION

Older participants in the intervention group will be paired with younger study partners and receive positive, daily messages over four weeks using a novel technology platform. The daily messages combine intergenerational social engagement (growing a virtual garden with a younger study partner) and prosocial goals (donations to charity after reaching step count goals).

MEASUREMENTS

The primary outcome is change in step count compared to baseline measured using a wrist-worn triaxial accelerometer. Secondary outcomes include time spent physically active, mood, generativity, loneliness, and cognition. Target mechanisms (social support and generativity) of physical activity engagement will be examined. Ease of use, acceptability, and feasibility of the technology as well as barriers and facilitators of participation will be assessed.

CONCLUSIONS

This research will advance our understanding of mechanisms and individual differences underlying successful physical activity engagement in older adults who are at risk for Alzheimer's disease. This knowledge will contribute to strategies for promoting health behaviours that can prevent the risk of Alzheimer's disease.

The InAbled Cities Project: Development of a Physical Activity Enhancement Program for Older Adults and People With Disabilities in Spain and Italy-A Feasibility Study

As life expectancies increase, people are tending toward more inactive lifestyles. Older adults and people with disabilities might benefit from accessible physical activities in nearby social networks. The purpose of this European InAbled Cities study is to develop and test the feasibility of a program aimed at enhancing physical activity for older adults and people with disabilities within their social networks. Participatory action research was conducted in two municipalities in urban (Bologna, Italy) and rural (Sevilla La Nueva, Spain) settings with older adults and people with disabilities, healthcare professionals, and communication managers. Data collection comprised a survey, interviews, and focus group interviews for developing a physical activity enhancement program, a mobile device application, and a citizen engagement strategy. Evaluation of the program's usability focused on feasibility, appropriateness, acceptability, and quality of life. The enhancement of physical activity in the two community-based settings revealed similarities and differences in the needs of citizens in the two participating municipalities. Similarities were related to behavioral change for enhancing physical activity. Differences in infrastructure were the main factors driving the need for contextual adaptations. Overall, participants were positive about the appropriateness, feasibility, and acceptability of the program. Participants deemed the physical activity enhancement programs in both communities feasible, thus indicating potential for the further implementation of the program. This research provides new insight into ways of enhancing physical activity in older adults and people with disabilities. Such insight could be used to customize such programs to specific needs.

Social capital and physical activity: a literature review up to March 2024

Background

Social capital, as a multidimensional social science concept, plays a crucial role in promoting physical activity. Despite numerous studies exploring the relationship between social capital and physical activity, there is still a lack of systematic understanding of how different dimensions of social capital influence physical activity levels. This study aims to systematically review the literature up to 2024 on the relationship between social capital and physical activity, uncover the role of social capital in promoting physical activity, and identify its multidimensional impacts.

Methods

We used a combination of search terms including "social capital" and "physical activity" to search the Web of Science, PubMed, Scopus, SportDiscus, and PsychINFO databases for English literature published up to March 1, 2024.

Results

We identified 2,021 unique articles and reviewed 115 studies that met our inclusion criteria. These studies evaluated various dimensions of social capital, with key dimensions including social participation (34%), social networks (30%), social cohesion (30%), social trust (29%), overall social network (26%), social support (19%), safety (19%), norms of reciprocity (13%), social control (10%), satisfaction with the environment (8%), collective efficacy (4%), norms for physical activity (3%), and voting (1%). In studies exploring the relationship between social capital and physical activity, the majority of positive results in the hypothesized direction were observed in dimensions such as social cohesion, trust, participation, reciprocity, satisfaction with the environment, and overall social networks. In contrast, dimensions such as voting, collective efficacy, safety, control, and physical activity norms predominantly showed null or negative results. The results for social support were mixed, displaying positive, negative, and null outcomes, while findings for social networks were also predominantly mixed.

Conclusion

This study reveals the significant role of social capital in promoting physical activity, particularly in the dimensions of social cohesion, social trust, social participation, norms of reciprocity, satisfaction with environment, and overall social network. When designing public health interventions in the future, it is crucial to tailor strategies to different populations and contexts to better leverage social capital in promoting physical activity.

Impact of a Community-Based Health Intervention on Health Knowledge, Lifestyle Goals, Dietary Practices, and Physical Activity in Older Adults: A Multisite Cohort Study

Background: Studies on the effectiveness of community-based health interventions (CBHIs) in improving lifestyle practices among older adults are limited. Objectives: This study evaluated the impact of a CBHI on health knowledge, lifestyle goal attainment, and practices among older adults in Singapore. Methods: Older adults (aged ≥60 years) were recruited from 29 senior recreation centres to participate in the "Wise and Well" programme, a 3-month CBHI designed to empower individuals to make healthier lifestyle choices. Pre- and post-programme assessments of health knowledge, goal attainment, and lifestyle behaviours (dietary practices and physical activity levels) were conducted using a health knowledge questionnaire, Goal Attainment Scaling (GAS), the Modified Dietary Practice Questionnaire (DPQ), and the Global Physical Activity Questionnaire (GPAQ), respectively. Statistical analysis was performed using the Wilcoxon signed-rank and McNemar's tests (α = 0.05). Results: The study comprised 464 participants (mean age 73.1 years [SD 7.6]; 75.9% women). Three months post-program, participants showed significantly increased health knowledge (p < 0.001) and improved lifestyle goal attainment (p < 0.001). Additionally, there was a significant increase in the proportion of participants meeting or exceeding fruit (p < 0.001) and vegetable (p = 0.002) intake recommendations and reductions in sugar-sweetened beverage consumption (p = 0.002). However, no significant changes were observed in fried food consumption or physical activity levels. High health knowledge scores were associated with 2.17 (95% confidence interval 1.02,4.64) times greater odds of increased vegetable intake. Conclusions: The CBHI shows potential as an effective approach to improving health knowledge and enhancing lifestyle goals and practices among older adults.

Emotional Status, Motor Dysfunction, and Cognitive Functioning as Predictors of Quality of Life in Physically Engaged Community-Dwelling Older Adults: A Structural Equation Modeling Approach

The demographic transition has become a reality, and it demands public policies to promote physical and mental health in aging. Group exercise emerges as a cost-effective and accessible alternative to promote active aging on a large scale, but to optimize the effectiveness of these programs, it is crucial to understand the underlying mechanisms that improve quality of life. This study aimed to explore the associations between emotional status, cognitive functioning, motor dysfunction, and their relationship with quality of life in community-dwelling older adults participating in a group physical exercise program. Structural equation modeling was used to explore these relationships in a sample of 190 older adults. Emotional state directly predicted all domains of quality of life. Motor dysfunction predicts the physical health domain of quality of life. Motor dysfunction and cognitive functioning are strongly correlated with emotional status. The fit indices of the final model are acceptable, and it demonstrates that within group-exercise dynamics, emotional status is the main component of quality-of-life promotion. Therefore, professionals designing group physical exercise programs to promote active aging should consider not only physical fitness, but also the integration of psychosocial elements, offering a holistic approach to enhancing overall well-being.

Implementation Evaluation of a Parks- and Faith-Based Multilevel Intervention to Promote Physical Activity Among Latinos

BACKGROUND

Latinos in the United States face multiple barriers to engaging in physical activity (PA). We implemented a faith-based multilevel intervention to promote PA in parks for Latino adults, which was partially adapted to a virtual platform during the COVID-19 pandemic, and evaluated it using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

METHODS

We conducted in-depth semistructured interviews (83% in Spanish) with 24 intervention participants (75% women) participating in a cluster randomized controlled trial in 2019-2022 that linked 6 churches (3 intervention, 3 control) with parks in East Los Angeles, CA. The intervention included in-person, park-based fitness classes, which were adapted to Facebook during the pandemic; PA motivational text messages; and other activities. Interviews assessed Reach (participation), Effectiveness (perceived impacts), Implementation (participation barriers/facilitators), and Maintenance (plans for sustaining PA), as well as perceived pandemic impacts.

RESULTS

About 80% of interviewees participated in ≥1 park class and 67% in ≥1 virtual class (Reach). Interviewees perceived positive intervention impacts across multiple health and well-being domains (Effectiveness) despite perceived negative pandemic impacts; several facilitators to participation (personal, social, program) and few barriers (personal, virtual, environmental; Implementation); and plans for maintaining PA (eg, revisiting intervention text messages and video recordings; Maintenance).

CONCLUSIONS

Findings support the utility of Reach, Effectiveness, Adoption, Implementation, and Maintenance to understand the broad impacts of a faith-based PA intervention. Findings point to the adaptability and robustness of the intervention during a public health crisis. Overall, findings may help inform the translation of the intervention to other communities to advance health equity.

Effects of activity participation and cognitive levels on depression in middle-aged and older adults with chronic illness: a national cross-sectional study

Introduction

The world population is rapidly aging, and depression mainly affects middle-aged and older adults with chronic diseases and cognitive impairments. The sample for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS) public database. The sample size for inclusion was 12,767. There were 6,773 females and 5,994 males, with an overall low level of education. This study aims to provide a theoretical and practical reference basis for the clinical non-pharmacological treatment of depression in middle-aged and older adults (age ≥ 50 years) with chronic diseases. Additionally, the study seeks to promote the development of mental health interventions for middle-aged and older adults (age ≥ 50 years) with chronic diseases, ultimately enhancing the sense of well-being and quality of life for this demographic.

Methods

Cognitive functioning and depressive symptoms of the study participants were assessed using the Mini-Mental State Examination Scale (MMSE) and the short version of the Center for Epidemiological Studies Depression Scale (CESD-10).

Results and discussion

Binary logistic regression results showed that among middle-aged and older adults (age ≥ 50 years) with chronic diseases, participation in physical activity [OR = 1.397; 95% CI (1.181-1.651); p < 0.05] was more effective than participation in social activities [OR = 0.997; 95% CI (0.924-1.076); p < 0.05] for preventing depression. Those with cognitive impairment [OR = 1.206; 95% CI (1.089-1.335); p < 0.05] were more likely to experience depression than those without cognitive impairment. Activity participation (physical activity and social activity) had a more significant effect on mild and moderate depression compared to no depression, and cognitive level had a more pronounced effect on moderate depression [OR = 1.491; 95% CI (1.278-1.740); p < 0.05] and major depression [OR = 2.231; 95% CI (1.282-3.884); p < 0.05]. Within the specific cohort of middle-aged and older adults (age ≥ 50 years) with chronic diseases, both activity participation and cognitive level exert a significant influence on the prevention and intervention of depression. Engagement in physical activity, participation in social activities, and enhanced cognitive functioning emerged as protective factors against depression. Therefore, the policy-maker should strengthen the prevention and treatment of depression in a comprehensive manner through the promotion of physical and social activities and the enhancement of cognitive level, so as to safeguard the mental health of middle-aged and older adults with chronic diseases.

Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study

OBJECTIVE

This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy.

METHODS

A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation.

RESULTS

A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline.

CONCLUSIONS

The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

Association between the level of social participation and depressive symptoms among older Japanese adults: a cross-sectional survey

BACKGROUND

Social participation is recommended for older adults to remain actively involved in daily life. Social participation is a broad concept, ranging from 'interacting with others without doing a specific activity with them' to 'actively contributing to society.' However, previous studies have not taken into account the components of social participation. Depressive symptoms are significant outcomes in older adults. Social participation mitigates these risks owing to its association with reduced mortality and enhanced quality of life. This study aimed to examine the association between the level of social participation and depressive symptoms in community-dwelling older adults.

METHODS

We included 17 040 individuals aged ≥65 years. Social participation was categorised into Level 3, interacting with others without doing a specific activity with them; Level 4, engaging in an activity with others; Level 5, helping others; and Level 6, contributing to society, based on a previous study by Levasseur et al. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Logistic regression models were used to examine the association between the level of social participation and depressive symptoms.

RESULTS

Overall, 15 069 older adults met the inclusion criteria. A higher level of social participation was associated with lower odds ratios (ORs) for depressive symptoms (Level 6 = OR: 0.43, 95% confidence interval (CI): 0.37-0.50; Level 5 = OR: 0.50, 95% CI: 0.41-0.60; and Level 4 = OR: 0.60, 95% CI: 0.52-0.69). Subgroup analyses based on age and sex yielded similar results across all participants.

CONCLUSIONS

Among older adults in Japan, a higher level of social participation was associated with lower rates of depressive symptoms. The relationship between depressive symptoms and the levels of social participation may help develop measures to reduce or prevent depressive symptoms in older adults.

Social interaction trajectories and all-cause mortality in older adults: the Otassha study

Introduction

This longitudinal study aimed to identify aging trajectory patterns of social interaction by sex and determine the association between these patterns and all-cause mortality.

Methods

Participants were 4,065 community-dwelling older adults (1849 men) in Japan, aged 65-89 years, who responded twice or more to a mail survey conducted between 2012 and 2020. Social interaction was examined through the frequency of face-to-face and non-face-to-face contact with non-resident family and friends. The aging trajectories of the social interaction scores were identified using group-based trajectory modeling.

Results

Two groups were identified among both men and women. Among men with high-frequency interaction, a rapid decrease in the frequency of social interaction was observed after 80 years of age. Conversely, among women, the frequency tended to remain the same, even after 80 years of age. The social interaction score among those aged 65 years in the low-frequency group was approximately 4 points for men and 6 points for women. Among men, no decrease was observed; however, it tended to decline after 85 years of age among women. Among men, the factors associated with the low-frequency group were instrumental activities of daily living score, perceived financial status, and social participation, while among women, they were self-rated health and social participation. The adjusted hazard ratio in the low-frequency group for all-cause mortality was 1.72 (95% confidence interval, 1.27-1.72) for men and 1.45 (95% confidence interval, 0.98-2.14) for women.

Discussion

In the low-frequency group, men had a higher risk of all-cause mortality than women. Daily social interaction from mid-age is important to reduce the risk of social isolation and all-cause mortality in later life.