Is exercise effective in promoting mental well-being in older age? A systematic review

Authors:
WINDLE Gill, et al
Journal article citation:
Aging and Mental Health, 14(6), August 2010, pp.652-669.
Publisher:
Taylor and Francis

The purpose of this study was to examine the clinical and cost effectiveness of exercise and physical activity interventions on mental well-being in people aged over 65 years. The researchers undertook a literature search for reports published in English, with a comparison or control group or offering qualitative evidence, concerning exercise and physical activity interventions, and including outcome measures of mental well-being. This article describes the methods used and studies identified. The meta-analysis highlights that exercise and physical activity can be effective in improving the mental well-being of people aged 65 and over, and the authors suggest that, as a minimum, the evidence indicates two exercise sessions per week of light to moderate intensity, each of a 45 minute duration. The article discusses findings and implications for policy, practice, and further research. The authors note that the effects found for selected groups of older people outside the UK would indicate that there is a need for more evidence of effectiveness from older people in the UK, particularly older males and minority ethnic groups.

Extended abstract:
Author

WINDLE Gill; et al.;

Is exercise effective in promoting mental well-being in older age? A systematic review.

Journal citation/publication details

Aging and Mental Health, 14(6), August 2010, pp652-669.

Summary

Twelve studies on effectiveness and one cost-effectiveness study, mainly from the USA, were included following quality assessment. Meta-analysis of four studies revealed a beneficial effect on mental well-being which was also suggested by the evidence from the other studies.

Context

NICE (National Institute of Clinical Excellence) guidance on the use of occupational therapy and physical exercise interventions to promote the mental wellbeing of older people in primary care was informed by a previously published systematic review. The aim of this study was to update and improve on the methodology of the exercise and physical activity section of the original review by conducting a meta-analysis and presenting an economic model.

Methods

What sources were searched?
Twenty five databases and eleven websites were searched for articles published in English between January 1993 and February 2007. The sources included government websites and those of organisations working in the field of elderly care and mental health; the supplementary information available online at http://www.bangor.ac.uk/imscar/dsdc/nice.php.en includes a full list of the sources searched. The reference lists of relevant, previously published, meta-analyses were hand searched.

What search terms/strategies were used?
A detailed search strategy, which was initially developed to run on Medline and later adapted to use in the other databases, is presented in the online supplementary data. Searches for effectiveness and cost-effectiveness were conducted separately. The searches were carried out by the NHS Centre for Reviews and Dissemination.

What criteria were used to decide on which studies to include?
Studies of the effectiveness, including cost-effectiveness, of exercise and physical activity interventions aimed at people aged 65 years and above, living at home, in the community, in supported housing, or in residential care homes were eligible for inclusion. Only interventions reporting validated mental health outcomes such as life satisfaction, SF-36 MCS score, self-esteem, happiness and mastery, or one of a list of health economics outcomes, including quality adjusted life years (QALYs), were included. Randomised controlled trials (RCTs), or studies with either a comparison or a control group, were eligible as were qualitative designs.

Who decided on their relevance and quality?
Initial screening was carried out by one reviewer and checked by a second reviewer. Full articles were assessed independently by two reviewers. Methodological quality was assessed using criteria based on those used by Ogilvie. Studies were excluded if they failed to meet at least half of the quality criteria. The screening process is illustrated in Figure 1.

How many studies were included and where were they from?
Over 15,000 titles were identified from the initial NICE review. Eighty seven papers underwent full assessment, 36 of which were considered relevant and were quality assessed. The excluded papers are listed in the online supplement. Twelve effectiveness studies and one cost effectiveness study were finally included in the review: 10 RCTs, one qualitative study, and one meta-analysis. The qualitative study was included to illustrate participants’ experiences. Nine studies were set in the USA, two in the UK, one in Australia, and one in Norway. 

How were the study findings combined?
Meta-analysis was performed on four interventions which measured mental well being using SF-36 mental health factor and self esteem. Effects sizes based on standardised mean differences were calculated using a random effects model and RevMan software. The study details and key findings are summarised in Table 2 and in the narrative.


 

Findings of the review

A range of interventions was examined: yoga, walking, Tai Chi, and balance training. Most of the participants were female. Meta-analysis of four studies with a total of 909 participants revealed an overall significant effect of exercise on mental well-being in the intervention group compared to a minimal intervention comparison group (standardised effect size 0.27, 95% CI 0.14 to 0.40). Overall, the findings of the other studies included in the review indicated some benefit on mental well-being related to an exercise intervention. The results of two studies indicated that benefits can extend to frailer older people.

All of the interventions had been designed for older people, delivered in a community setting by trained instructors and targeted at those who were sedentary. There was insufficient information to allow firm conclusions on the optimum number of sessions per week or the duration of the sessions. One study of a community walking scheme had sufficient data to allow economic modelling and appeared to be a cost-effective way of promoting mental well-being. The single cost-effectiveness study reported that a community-based twice-weekly exercise class was cost effective.

Authors' conclusions

‘Mental well-being in later life is modifiable through exercise and physical activity. To generalise the findings there is a need for more evidence of effectiveness from older people in the UK.’

Implications for policy or practice

Service providers need to ‘consider that exercise interventions should be specific for the target age group and appropriately supervised’.

Related references

Windle et al. (2007). Public Health interventions to promote mental well-being in people aged 65 and over: systematic review of effectiveness and cost-effectiveness. London: National Institute of Health and Clinical excellence. 
http://www.nice.org.uk/guidance/index.jsp?action=download&o=42401

 


 

Subject terms:
mental health, older people, physical exercise;
Content type:
systematic review
Link:
Journal home page
ISSN online:
1364-6915
ISSN print:
1360-7863

Key to icons

  • Free resource Free resource
  • Journal article Journal article
  • Book Book
  • Digital media Digital media
  • Journal Journal

Give us your feedback

Social Care Online continues to be developed in response to user feedback.

Contact us with your comments and for any problems using the website.

Sign up/login for more

Register/login to access resource links, advanced search and email alerts