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Background Physical activity (PA) has multiple important benefits for older adults, but many do not undertake the recommended amount. This systematic review examined the quantitative literature detailing barriers and motivators to PA in older adults: a concurrent qualitative review is underway. Previous reviews investigated younger age groups or specific diseases. Method We included adults ≥70 years, observational studies and baseline data for randomised controlled trials (RCTs); we excluded studies of specific disease groups, care home residents, and rates of cognitive impairment above population norms. We searched Medline, Embase, CINAHL and PsycINFO on 25th February 2020. We assessed risk-of-bias using ROBANS. We undertook a narrative review; meta-analysis was not possible. The protocol was registered on PROSPERO (CRD42021160503). Results We identified 35 papers (24 cross-sectional studies, eight prospective cohort studies, two studies of baseline data from RCTs and one mixed method study); n = 26,264 subjects, median age 77.7 years (range 70–101) and median percentage female 62.1% (range 0–100). Quality assessment identified low risk-of-bias overall, except two studies were identified as having a high risk-of-bias for one section (confounding variables). The most cited barriers were physical health (N = 14 studies), environmental factors (N = 12), fear of falls (N = 7) and lack of interest (N = 4). Other barriers identified were lack of company (N = 1) and urine leakage (in women) (N = 1). Key motivating factors included social aspects of PA (N = 8), intrinsic/psychological (e.g. self-determination, future orientation) (N = 8), health (e.g. doctor’s advice) (N = 7) and environmental (e.g. nearby green space) (N = 4). Discussion This review identified key barriers and motivators to PA in older adults. There is a lack of evidence for the oldest old. These findings should be used to create trials of suitable interventions which enable older adults to take up and maintain recommended levels of PA. The wide range of factors we identified indicates an individualised approach may be best.

Introduction Despite the myriad advantages associated with physical activity (PA), older adults are often insufficiently active to maximise health benefits. Understanding factors that influence engagement in PA will support practitioners in providing well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adult’s engagement in PA. Method Four electronic databases were searched: CINAHL, Embase, MEDLINE and PsycINFO. Inclusion criteria were community-dwelling older adults (≥70 years), and studies including qualitative method. Exclusion criteria were studies examining a single disease group, individuals with cognitive impairment, care home residents, and PA interventions. The Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological rigour. Framework synthesis using the COM-B model was applied to analyse data, and the GRADE-CERQual approach was used to assess confidence in findings. (PROSPERO: CRD42021160503). Results Twenty-one studies were included in the review. Participants (N = 3,955; mean age 78.9 years) included 64% female and 36% male older adults. Most studies were methodologically rigorous (17/21 scored ≥8 CASP). We identified 32 themes mapped against the COM-B framework (16 high confidence). Older adult’s perceived capability was influenced by their functional capacity, illness symptoms and perceived risk of injury from PA. PA was motivated by identifying as an ‘exerciser’, health gains and positive emotions (e.g. enjoyment), while negative sensations reduced motivation (e.g. pain). Opportunity was impacted by the weather, the environment ‘fit’, and the availability of social interaction during PA. Moreover, social opportunity was impacted by socio-cultural ageing stereotypes and discourses, influencing older adults’ PA through media outlets, social norms, and self-stigma. Conclusion The review found a complex web of interacting factors that influenced older people’s PA between the sub-domains of capability, motivation, and opportunity. Future initiatives to increase PA in older adults should focus on social influences, environmental barriers, and physical limitations.

Introduction: sedentary behaviour among older inpatients is associated with increased risk of functional decline, institutionalisation and death. Studies have shown that exercise and mobility interventions can reduce the risks of some of these adverse effects. However, most studies use paid staff to deliver such interventions. We explored the feasibility and acceptability of training volunteers to promote increased physical activity among older inpatients. Methods: this pre-post mixed methods study was conducted on acute medical wards for older people. Eligible patients were aged ≥70 years, mobile prior to admission and able to provide written consent. Physical activity levels were measured using two accelerometers: the ankle-worn StepWatch Activity Monitor and wrist-worn GENEActiv. Volunteers were trained and supported by therapists to deliver individual twice-daily activity sessions, which consisted of walking, chair, and/or bed exercises. Six nurses, seven therapists, six volunteers and six patients were interviewed to determine their views of the intervention. Results: 50 participants pre-intervention (mean age 87 years, SD 4.6) had a median daily step count of 626 (IQR 298–1468) and mean daily acceleration of 9.1 milligravity (SD 3.3) ( Conclusions: findings from this study demonstrate the sedentary behaviour of older medical inpatients. Trained volunteers can safely deliver mobility and exercise interventions for older inpatients. A controlled trial is required to determine the impact of trained volunteers on patient outcomes.