Article type
Year
Abstract
Background: Physical inactivity is a leading cause of preventable death and morbidity in developed countries. In addition, physical activity can potentially be an effective treatment for various medical conditions (e.g. cardiovascular disease, osteoarthritis).
Although the benefits of active living among those 50 years and older are widely accepted, there has not been to date a systematic review of the world literature to determine what types of physical activity programs are the most effective in this population.
Objectives: To assess the effectiveness of home based versus center based physical activity programs on the health of older adults.
Methods: We searched the Cochrane Controlled Trials Register (1991-present), MEDLINE (1966-present), EMBASE (1988 to present), CINAHL (1982-present), Health Star (1975-present), Dissertation Abstracts (1980 to present), Sport Discus (1975-present) and Science Citation Index (1975-present), reference lists of relevant articles and contacted principal authors where possible.
Randomised or quasi-randomised controlled trials of different physical activity interventions in older adults (50 years or older). The study had to include a direct comparison of a home based versus a center based exercise program. Study participants in the accepted trials had either a recognised cardiovascular risk factor, or existing cardiovascular disease, or chronic obstructive airways disease (COPD) or osteoarthritis.
Three reviewers selected and appraised the identified studies independently.
Results: Eventually six eligible trials were accepted for this systematic review. Collectively they included 224 participants who received a home-based exercise program and 148 who received a center-based exercise program. Five studies were of medium quality and one poor. The largest trial (accounting for approximately 60% of the participants) looked at sedentary older adults, two trials looked at older adults with COPD and the remaining three looked at patients with peripheral vascular disease (intermittent claudication). A meta analysis was not undertaken given the heterogeneity of these studies.
Many of the studies were able to demonstrate various positive improvements in function, quality of life, and various cardiovascular and respiratory related outcomes, for both home and center based programs when compared with baseline measures. However most of these measures were not significantly different between the two types of programs. None of the studies dealt with measures of cost, or health service utilization.
Notably however home based programs had a significantly higher adherrence rate than center based programs. One study of sedentary older adults (accounting for 60% of the total participants in the systematic review) showed an adherrence rate of 68% in the home based program at two year follow-up compared with a 36% adherrence in the center based group.
Conclusions: Home based programs appear to be superior to center based programs in terms of the adherrence to exercise (especially in the long term). For every one individual continuing to exercise after a center based program, two individuals will be exercising after a home based program. This may well translate into home based programs being more cost effective than center based programs although no studies have looked specifically at this.
Although the benefits of active living among those 50 years and older are widely accepted, there has not been to date a systematic review of the world literature to determine what types of physical activity programs are the most effective in this population.
Objectives: To assess the effectiveness of home based versus center based physical activity programs on the health of older adults.
Methods: We searched the Cochrane Controlled Trials Register (1991-present), MEDLINE (1966-present), EMBASE (1988 to present), CINAHL (1982-present), Health Star (1975-present), Dissertation Abstracts (1980 to present), Sport Discus (1975-present) and Science Citation Index (1975-present), reference lists of relevant articles and contacted principal authors where possible.
Randomised or quasi-randomised controlled trials of different physical activity interventions in older adults (50 years or older). The study had to include a direct comparison of a home based versus a center based exercise program. Study participants in the accepted trials had either a recognised cardiovascular risk factor, or existing cardiovascular disease, or chronic obstructive airways disease (COPD) or osteoarthritis.
Three reviewers selected and appraised the identified studies independently.
Results: Eventually six eligible trials were accepted for this systematic review. Collectively they included 224 participants who received a home-based exercise program and 148 who received a center-based exercise program. Five studies were of medium quality and one poor. The largest trial (accounting for approximately 60% of the participants) looked at sedentary older adults, two trials looked at older adults with COPD and the remaining three looked at patients with peripheral vascular disease (intermittent claudication). A meta analysis was not undertaken given the heterogeneity of these studies.
Many of the studies were able to demonstrate various positive improvements in function, quality of life, and various cardiovascular and respiratory related outcomes, for both home and center based programs when compared with baseline measures. However most of these measures were not significantly different between the two types of programs. None of the studies dealt with measures of cost, or health service utilization.
Notably however home based programs had a significantly higher adherrence rate than center based programs. One study of sedentary older adults (accounting for 60% of the total participants in the systematic review) showed an adherrence rate of 68% in the home based program at two year follow-up compared with a 36% adherrence in the center based group.
Conclusions: Home based programs appear to be superior to center based programs in terms of the adherrence to exercise (especially in the long term). For every one individual continuing to exercise after a center based program, two individuals will be exercising after a home based program. This may well translate into home based programs being more cost effective than center based programs although no studies have looked specifically at this.