The effectiveness of physical leisure time activities on the older adult's physical functioning: A Systematic Review Centre conducting review The Taiwan Joanna Briggs Institute Collaborating Centre: A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan Primary reviewer/contact Lee-Wen Pai, RN, MSN, Lecturer 1.2 Contact: [email protected] Second reviewer Wei Chen, RN, MSN, Lecturer 1.2 Reviewer panel: Hsin Li Liu, RN, MSN, Lecturer1.2 Tsai Hsun, Lin, RN, MSN 2 1. Central Taiwan University of Science and Technology. 2. A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan Review Questions/Objectives The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on older adult's physical functioning including gait speed, grip strength, six-minute walk, balance, activity of daily living(ADL). Background Population ageing is progressing rapidly in many industrialized countries and is expected to be among the most prominent of global demographic trends in the 21st century. According to data from the World Health Organization, the life expectancy of the world population were 68 years in 2009, while recent demographic Census data in Brazil has reported that about 10 million people in their population are currently greater than 65 years of age.1,2 As a consequence of the ageing process, older adults over 60 years old can often experience a decline in their physical functioning and chronic health problems, and associated with this, also experience changes in life style3,4,5,6,7. It has been suggested that age related physical limitations such as impaired balance and mobility as well as decreased muscle strength of the limbs contribute to decreased quality of life8 in elderly people 9,10. In addition, owing to cerebral cortex degeneration, the elderly can experience cognitive functioning problem associated with motor function.11 In light of these factors, preserving or improving functional status, mobility and independence in old age is important for both the older adult and for society at large 12,13. Therefore, strategies to prevent deterioration or improve the older adults physical functioning have become issues of significance in many countries14, and primary research has investigated many aspects of aging in relation to quality of life15, and physical functioning.16, Physical activity on a regular basis has been shown to contribute to healthy ageing17,18. Studies have reported on the benefits of a range of physical activities including daily living activity, leisure time activity, and therapeutic exercise.19,20. Regular physical leisure time activities on older adults are defined as at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate and vigorous-intensity activity.21 Vigorous leisure time activities included jogging, cycling, and swimming. Moderate leisure time activities included walking, gardening, tai chi chuan, and qigong(an ancient Chinese breathing exercise that combines aerobics, isometric, and isotonic movements and meditation).22,23 Studies therefore suggest that physical leisure time activity could offer positive influences on chronic diseases including diabetes and coronary heart disease.24,25 Accumulating data supports the belief that physical leisure time activity may also be associated with psychological health26, beneficial impact on neurodegenerative diseases 27 as well as health-related quality of life28. Current research such as the study undertaken by Garatachea and colleagues (2009) emphasizes the positive functional and psychological effects of physical activity to maintain the independence of elderly people.29 The beneficial effects of physical leisure time activity in the elderly have largely been attributed to its impact on physical function through a diverse range of interventions. The results of individual studies suggests regular physical leisure time activity that improves physical functioning including muscle strength and power30, balance31, flexibility32, range of motion33, and ability of daily living.33However, a significant proportion of the elderly do not have regular leisure time activity habits, with figures ranging from 18% to 60% in Europe34 and United States respectively.35 Several studies have examined the use of moderate or vigorous leisure time activity programs to improve older adult's physical functioning. Duration of the programs were 30-60 min, 3 times per week at an outdoor track for 3 months to 12 months.36,37 Researchers used indicators of physical function including gait speed, grip strength, six-minute walk, balance, and activity of daily living (ADL).38,39A brief description of these tests follows. Gait speed was assessed by recording the time (in seconds) an individual required to walk over 15.24 meters at usual speed twice and then at fastest speed twice, and the mean speed(m/s) was calculated40. Grip strength was evaluated with the individual sitting with the arm by the side and elbow at 90 degrees of flexion, using a Jamar hand grip dynamometer41. Six-minute walk records the maximal distance (in meters) an individual can walk back and forth in a 30 meter long corridor in six minutes42.Two measures were used to assess balance: function reach43and standing balance.44Functional reach measures the maximal distance (cm) reached forward by an individual standing with an outstretched arm at the shoulder level. Standing balance was evaluated by side by side stance (feet side by side, touching), semi tandem stance (one foot placed forward with the heel in with, and adjacent to, the toes of the other foot), and tandem stance (heel of one foot directly in front of and touching the toes of the other foot). Activity of daily living was described an individual can perform ability of eating, dressing, bathing, walking, grooming, and using the toilet. Activity of daily living was evaluated by questionnaires consisted of Katz ADL scale, Barthel Index, PPT (Physical performance test).45 This systematic review aims to explore the effectiveness of leisure time activity to improve older adult's physical functioning including gait speed, grip strength, six-minute walk, functional reach, balance, and ability of daily living. A preliminary search of MEDLINE, DARE database, CINAHL, the Cochrane Library of Systematic Reviews and Joanna Briggs Institute Library of Systematic Reviews found no existing reviews or review underway on this topic. For the purposes of this system reviews the following definitions were used: Leisure time activities Regular physical leisure time activities on older adults are defined as at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate and vigorous-intensity activity.21 Older adults: Older adults are defined over 60 years old. 1 Physical functioning: Physical functioning including muscle strength and power, balance, flexibility, range of motion, and activity of daily living.46 Long-term care facility: Long-term care facilities included residential home and nursing home.47 Inclusion Criteria Types of participants This review will consider the older adults over 60 years old living in the community, and long-term care facility participating in physical leisure time activities. The exclusion criteria include the following: intellectual or psychiatric disability such as dementia; history of any illness contraindicating physical activity or limiting participation in the physical activity program; communication problems, and taking medication such as psychotherapeutic agents and skeletal muscle relaxants known to affect activities such as gait speed, grip strength, six-minute walk, balance, or activity of daily living (ADL). Types of Interventions Regular leisure time activities on older adults are defined as as at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate and vigorous-intensity activity. The review will consider studies on the effectiveness of regular time activities to improve the elderly's physical functioning, including the following forms of exercise: The leisure time activities will include but are not limited to: 1.jogging 2.tai chi exercise 3.walking 4.cycling 5.swimming 6.gardening 7.gigong(an ancient Chinese breathing exercise that combines aerobics, isometric, and isotonic movements and meditation) Types of outcomes The outcome measures will include, but are not limited to: (1) gait speed (2) grip strength (3) six-minute walk (4) balance (5) activity of daily living(ADL) Types of Studies The review will consider any randomised controlled trials (RCTs) that examine leisure time physical activity to improve the elderly's physical functioning. Regular leisure time physical activity will be defined as moderate or vigorous physical activity during leisure time of 20 minutes duration at least 3 times per week. In the absence of RCTs, controlled clinical trials, cohort and case-control studies will be considered for inclusion to enable the identification of current best evidence. Studies reported in English and Chinese languages will be included in the review. Search Strategy The search strategy will be limited to the following years from 1960 to 2011.The search strategy aims to find both published and unpublished studies and papers in English and Chinese languages. A three-step search strategy will be utilized in this review. An initial limited search of PubMed and CINAHL Plus with full text will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken (Appendix I). Thirdly, the reference list of all identified reports and articles will be searched for additional studies. The databases to be searched will include: CINAHL Plus with Full Text Scopus PubMed Academic Search Complete The Cochrane Library of Controlled Trials DARE databases (Database of Abstracts of Reviews of Effectiveness) Mednar Proquest Conference Proceedings Dissertation Abstracts International Search item and keywords to be used will be: population elder older people older adults ageing Intervention leisure time activity jogging tai chi exercise walking cycling swimming gardening gigong outcomes physical functioning gait speed grip strength six-minute walk balance activity of daily living (ADL) Assessment of Methodological Quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix II). Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer. Data Collection Quantitative data will be extracted from papers included in the review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix III). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer. Data Synthesis Where possible, quantitative research study results will be pooled in statistical meta-analysis using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). All results will be double entered. Odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible the findings will be presented in narrative form. Conflicts of Interest There are no conflicts of interest.
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A 2011 study studied this question.