Using existing guidelines to generate recommendations for promoting physical activity among older people: a GRADE approach

Article type
Authors
Yeh C1, Tiao M2
1Postgraduate Student, School of Nursing, Tzu Chi University, Hualien, Taiwan
2Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Abstract
Background: Older people are recommended to participate in exercise activities but they may not even understand what exercise is according to results from a qualitative interview study.

Objective: To generate a physical activity recommendations for both older people and health care professionals who have a role in instructing and promoting physical activity among older people.

Methods: A systematic search of the existing guidelines was conducted using a range of electronic and evidence-based databases. Grading of Recommendations assessment, Development and Evaluation (GRADE) was used to grade overall guideline recommendations, which comprises six dimensions: balance of desirable and undesirable consequences, quality of evidence, values and preferences of target population, resources use, feasibility and culture appropriateness. Experts who have a role to instruct or educate physical activity among older people were invited to grade the integrated physical activity recommendations with the use of GRADE.

Results: A total of five guidelines were identified, two from American College of Sports Medicine and one each from The National Institute for Clinical Excellence (NICE), Austrian Department of Health and Ageing and Canadian Fitness and Lifestyle Research Institute. The five guidelines or recommendations were integrated into the parts for both older people and health care professionals. In addition to physical activity recommendations on frequency, duration and intensity, evidence suggests that older people are encouraged to be physically active by making plans and by improving exercise self-efficacy.

Conclusions: The process combined a systematic search of existing guidelines and an assessment of confidence in estimates of effect of the existing guidelines to generate a list of recommendations for promoting physical activity among older people with an approach of the use of GRADE. Effective ways of providing tailored recommendations of physical activity for older adult population were listed. Future study tested feasibility and effectiveness of the recommendations is warranted.