Predictors of adherence to prescribed exercise programs for older adults with medical or surgical indications for exercise: a systematic review

Abstract

Background and objectives 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. Methods 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. Results 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. Conclusions 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. Systematic review registration PROSPERO CRD42018108242

Effects of Exercise Behavior, Social Cohesion, and Social Support on Health Behaviors in Older Adults: Intervention in a Multi-Component Exercise Program

“…The research team conducted exercise teaching and supervision, controlling the intensity of the exercise for the older adults when implementing the plan; thus, through group exercise, social support was engendered, such as increasing social opportunities and establishing mutual network communities. The fact that the exercise intervention virtually established adherence was a result, which was consistent with many studies [52,[106][107][108][109].…”

Predictors of real‐world adherence to prescribed home exercise in older patients with a risk of falling: A prospective observational study

“…Surprisingly, self‐efficacy for exercise was negatively associated with exercise adherence, contradicting previous research 29,30,39–41 . This could be due to overestimation of task demands when requirements are unclear, while underestimation leads to underconfidence 42 .…”

Adherence and potential factors of adherence to a resistance, coordination and endurance training in older retirement home residents over 6 months

“…31 In other exercise settings, similar results were reported for physical activity history, but no clear evidence was found regarding whether a previous exercise history predicts exercise adherence. 17,31 In contrast to existing literature, the results of our analysis revealed that BMI, health status and quality of life were not predictors of exercise adherence. Exercise self-efficacy was a positive predictor only in our univariate analysis.…”

“…31 Regarding demographic factors, age and sex did not affect exercise adherence in the included exercise interventions of the systematic review. 31 In other exercise settings, similar results were reported for physical activity history, but no clear evidence was found regarding whether a previous exercise history predicts exercise adherence. 17,31 In contrast to existing literature, the results of our analysis revealed that BMI, health status and quality of life were not predictors of exercise adherence.…”