Physical Activity: Digital Health Interventions for Adults 55 Years and Older

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity:

Muellmann S, Forberger S, Mollers T, Broring E, Zeeb H, Pischke CR. Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review. Preventive Medicine 2018;108:93-110.

The published review included 20 studies (search period through March 2017). The CPSTF finding is based on results from the published review, additional analyses of data from included studies, and expert input from team members and the CPSTF.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review and meta-analysis included 20 studies.

• Compared to interventions without a digital health intervention or to usual care, digital health interventions increased physical activity by 28% (17 studies).
  • Web-based interventions increased physical activity by a median of 28% (9 studies)
  • Telephone-based interventions increased physical activity by a median of 42% (5 studies)
  • Text message-based interventions increased physical activity by a median of 23% (3 studies)

A systematic review of economic evidence has not been conducted.

Based on results from the review, findings should be applicable to recruited adults aged 55 years and older. Reporting of other participant characteristics including socioeconomic status, race, and ethnicity was limited.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• What are the longer-term effects of these interventions (i.e., 6-12 months following implementation)? Longer term studies would allow researchers to examine the effects of increased physical activity on clinical and health outcomes.
• How do interventions affect rates of injuries, including falls? How do rates vary between active, inactive, and comparison group participants?
• How does effectiveness vary by participant race, ethnicity, and socioeconomic status?
• How are participation and effectiveness affected by the integration of enhanced technologies, such as smartphones, with monitoring functions?

• Studies included 18 randomized controlled trials and two quasi-experimental designs.
• Studies were conducted in the United States (11 studies), The Netherlands (3 studies), Belgium (2 studies), Australia (1 studies), New Zealand (1 study), Spain (1 study), and Malaysia (1 study).
• Interventions used web or internet content (9 studies), telephone contact (6 studies), text messages (3 studies), and a mobile application (app; 1 study).
• Interventions were provided for a median of 3 months.
• The median age of study participants was 64 years. In four studies, the median age of recruited adults was 70 years or older, and results from this subset were similar to the overall findings.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Muellmann S, Forberger S, Mollers T, Broring E, Zeeb H, Pischke CR. Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review. Preventive Medicine 2018;108:93-110.

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications)..

Effectiveness Review

Bickmore TW, Silliman RA, Nelson K, Cheng DM, Winter M, et al.. A randomized controlled trial of an automated exercise coach for older adults. J Am Geriatr Soc 2013;61:1676 83.

Freene N. Physiotherapist-led home-based physical activity program versus community group exercise for middle-aged adults: quasi-experimental comparison. Open J Prev Med 2013;3.

Freene N, Waddington G, Davey R, Cochrane T.Longitudinal comparison of a physiotherapist-led, home-based and group-based program for increasing physical activity in community-dwelling middle-aged adults. Aust J Prim Health 2015;21:189 96.

Irvine AB, Gelatt VA, Seeley JR, Macfarlane P, Gau JM. Web-based intervention to promote physical activity by sedentary older adults: randomized controlled trial. J Med Internet Res 2013;15:e19.

Jarvis KL, Friedman RH, Heeren T, Cullinane PM. Older women and physical activity: using the telephone to walk. Women’s Health Issues 1997;7:24 9.

Kim BH, Glanz K. Text messaging to motivate walking in older African Americans: a randomized controlled trial. Am J Prev Med 2013;44:71 5.

King AC, Friedman R, Marcus B, Castro C, Napolitano M, et al. Ongoing physical activity advice by humans versus computers: the community health advice by telephone (CHAT) trial. Health Psychol 2007;26:718 27.

King AC, Ahn DK, Oliveira BM, Atienza AA, Castro CM, et al. Promoting physical activity through hand-held computer technology. Am J Prev Med 2008;34:138 42.

King AC, Bickmore TW, Campero MI, Pruitt LA, Yin JL. Employing virtual advisors in preventive care for underserved communities: results from the COMPASS study. J Health Commun 2013b;18:1449 64.

Kolt GS, Schofield GM, Kerse N, Garrett N, Oliver M. Effect of telephone counseling on physical activity for low-active older people in primary care: a randomized, controlled trial. J Am Geriatr Soc 2007;55:986 92.

Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, et al. mActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc 2015;4.

Martinson BC, Crain AL, Sherwood NE, Hayes M, Pronk NP, et al. Maintaining physical activity among older adults: six-month outcomes of the keep active Minnesota randomized controlled trial. Prev Med 2008;46:111 9.

Martinson BC, Sherwood NE, Crain AL, Hayes MG, King AC, et al. Maintaining physical activity among older adults: 24-month outcomes of the keep active Minnesota randomized controlled trial. Prev Med 2010;51: 37 44.

Mouton A, Cloes M.Efficacy of a web-based, center-based or combined physical activity intervention among older adults. Health Educ Res 2015;30:422 35.

M ller AM, Khoo S, Morris T.Text messaging for exercise promotion in older adults from an upper-middle-income country: randomized controlled trial. J Med Internet Res 2016;18:e5.

Muntaner-Mas A, Vidal-Conti J, Borras PA, Ortega FB, Palou P. Effects of a whatsapp-delivered physical activity intervention to enhance health-related physical fitness components and cardiovascular disease risk factors in older adults. J Sports Med Phys Fitness 2017;57:90 102.

Peels DA, Bolman C, Golsteijn RH, de Vries H, Mudde AN, et al. Long-term efficacy of a printed or a web-based tailored physical activity intervention among older adults. Int J Behav Nutr Phys Act 2013;10:104.

Peels DA, van Stralen MM, Bolman C, Golsteijn RHJ, de Vries H, et al. The differentiated effectiveness of a printed versus a web-based tailored physical activity intervention among adults aged over 50. Health Educ Res 2014;29:870 82.

Pinto BM, Goldstein MG, Ashba J, Sciamanna CN, Jette A. Randomized controlled trial of physical activity counseling for older primary care patients. Am J Prev Med 2005;29:247 55.

Thompson WG, Kuhle CL, Koepp GA, McCrady-Spitzer SK, Levine JA. “Go4Life” exercise counseling, accelerometer feedback, and activity levels in older people. Arch Gerontol Geriatr 2014;58:314 9.

Van Dyck D, Plaete J, Cardon G, Crombez G, De Bourdeaudhuij I. Effectiveness of the self-regulation eHealth intervention ‘MyPlan1.0.’ on physical activity levels of recently retired Belgian adults: a randomized controlled trial. Health Educ Res 2016;31:653 64.

van Stralen MM, de Vries H, Mudde AN, Bolman C, Lechner L. The working mechanisms of an environmentally tailored physical activity intervention for older adults: a randomized controlled trial. Int J Behav Nutr Phys Act 2009;6.

van Stralen MM, de Vries H, Bolman C, Mudde AN, Lechner L.Exploring the efficacy and moderators of two computer-tailored physical activity interventions for older adults: a randomized controlled trial. Ann Behav Med 2010;39:139 50.

van Stralen MM, de Vries H, Mudde AN, Bolman C, Lechner L.The longterm efficacy of two computer-tailored physical activity interventions for older adults: main effects and mediators. Health Psychol 2011;30:442 52.

Wijsman CA, Westendorp RGJ, Verhagen E, Catt M, Slagboom E, et al. Effects of a web-based intervention on physical activity and metabolism in older adults: randomized controlled trial. J Med Internet Res 2013;15:13.

Effectiveness Review

Refer to the existing systematic review for information about the search strategy:

Muellmann S, Forberger S, Mollers T, Broring E, Zeeb H, Pischke CR. Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review. Preventive Medicine 2018;108:93-110.

Muellmann S, Forberger S, Mollers T, Broring E, Zeeb H, Pischke CR. Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review. Preventive Medicine 2018;108:93-110.

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Smartphones are increasingly common devices, even among older adults. Future interventions developed for smartphones will be able to incorporate web content, telephone contact, text messages, and apps.
• Scalability of community-based digital health interventions will likely depend on the use and capabilities of devices owned by recruited participants.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of adults who do no physical activity in their free time — PA‑01