Framework to Classify Physical Activity Intervention Studies for Older Adults

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There is an urgent need to increase physical activity levels among older adults (1). Although robust evidence supports many physical activity interventions, implementation remains a challenge (2). Physical activity programs are often considered complex interventions, comprising multiple interacting components (3). Poor reporting of complex interventions can hinder effective implementation because it can be difficult for end users to replicate the intervention. There is no agreed framework to classify physical activity intervention studies for older adults. This lack of consensus affects how results from intervention studies are reported and interpreted, precluding the ability to make meaningful comparisons and recommendations across different populations and contexts. Existing checklists, such as the Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT), are valuable in providing a comprehensive structure to classify interventions at a level sufficient for replication (4,5). However, these checklists do not classify characteristics of the study population, which are important for policymakers and program providers to consider when implementing interventions in real-world settings. When conducting our previous scoping review of physical activity interventions for older adults, we recognized the need to develop a standardized method to classify studies to assist with program implementation as well as study reporting, data extraction, and consolidation of evidence (6). The early iteration of our framework has since undergone extensive testing, modification, and evaluation during a rapid review on the effectiveness of physical activity programs and services for older adults (6). In this commentary, we outline the two-phase development process for and present the final version of a framework for classifying physical activity intervention studies for older adults. PHASE 1: INITIAL DEVELOPMENT OF THE FRAMEWORK An expert panel of seven clinicians and researchers in physical activity, aging, and implementation science participated in regular meetings to develop the framework. International physical activity experts, including from the World Health Organization (WHO), were also consulted throughout the development process. The structure and content of the framework was informed by (i) the WHO Global Action Plan on Physical Activity (GAPPA) (7), (ii) the TIDieR checklist (4), (iii) the CERT (5), (iv) the Prevention of Falls Network Europe (ProFaNE) taxonomy (8), (v) the WHO International Classification of Functioning, Disability and Health (ICF) (9), (vi) the World Report on Ageing and Health (10), (vii) the International Consortium for Health Outcomes Measurement (ICHOM) Standard set of health outcome measures for older persons (11), (viii) the recommended minimum data set of implementation indicators (12), and (ix) the Consolidated Standards of Reporting Trials (CONSORT) checklist (13). The GAPPA calls for physical activity programs and services to improve opportunities for physical activity for older adults (GAPPA Action 3.4), outlining a range of program settings and approaches to physical activity program provision and identifying important subpopulations (7). We considered all of these elements and included additional items to provide a greater level of detail about the type of physical activity provided, the outcomes achieved, and the broader context of the intervention. The TIDieR checklist, CERT, and ProFaNE taxonomy informed the development of the intervention section of the framework (4,5,8). Where appropriate, terminology from these resources was modified to optimize relevance to a physical activity audience. The item descriptors provide further information about how TIDieR and CERT items relate to the items within the current framework. The ICF, the World Report on Ageing and Health, the ICHOM Standard set of health outcome measures for older persons, and the recommended minimum data set of implementation indicators were used to guide the development of the outcomes section of the framework (9–12). The ICF concepts of “Body Structure and Function,” “Activities,” and “Participation” informed the “Intrinsic Capacity,” “Functional Ability,” and “Social Domain” items of our framework (9). Additional items were included to focus on outcomes targeted specifically by physical activity interventions. Outcomes relevant to physical activity interventions were included from the ICHOM Standard set of outcome domains for older people (11). The CONSORT checklist was used throughout the development process to ensure all relevant aspects of an intervention study—participants, interventions, and outcomes—were captured (13). The CONSORT checklist contains additional items critical to the reporting of clinical trials, but they are beyond the intended scope of our framework (e.g., participant recruitment, randomization, and statistical methods) (13). Our intention was for our proposed framework be used in parallel with the relevant CONSORT checklist when reporting intervention studies. PHASE 2: PILOT TESTING AND REFINEMENT OF THE FRAMEWORK The framework was extensively pilot tested during our previous scoping review of systematic reviews of physical activity interventions and a recent rapid review of intervention studies (6,14). We further tested the framework using primary studies that evaluated different types of physical activity interventions in various settings, locations, and populations. Modifications were made to the framework based on group discussion to achieve consensus, with final decisions made by the senior author (C.S.). We also received feedback from experts at WHO through a series of meetings presenting the framework development progress. This iterative process continued throughout the scoping review and rapid review, when the framework was continuously tested, evaluated, and refined during data extraction and synthesis of primary studies. OVERVIEW OF THE FRAMEWORK The framework uses the Population Intervention Comparator Outcome (PICO) structure to classify intervention studies (15) (Table 1). The PICO structure allows for the classification of all aspects that are relevant to study design and implementation (15). For each PICO item, there are further PICO aspects of interest, under which there are up to four levels of classification (Table 1). For example, a strengthening intervention would be classified as intervention (PICO item) – type of activity (PICO aspect of interest) – structured exercise (classification level 1) – strength, resistance, power (classification level 2) – yes (classification level 3) – specify (classification level 4). Each framework item has an accompanying descriptor, which outlines the item definition and any relevant information (table, Supplemental Content 1, https://links.lww.com/TJACSM/A225). The accompanying descriptors provide detailed information for each framework item to enable use in research and program implementation. TABLE 1 - Framework for Classifying Physical Activity Programs and Services for Older Adults. PICO Item PICO Aspect of Interest Framework Classification Level 1 Framework Classification Level 2 Framework Classification Level 3 Framework Classification Level 4 Population—Older adults Context Country High income Specify Upper-middle income Specify Lower-middle income Specify Low income Specify Mixed Specify Not specified Remoteness Rural/remote Urban Both Not specified Other Specify Individual factors Age ≥50 years ≥60 years ≥65 years ≥70 years ≥75 years ≥80 years ≥85 years ≥90 years Other Specify Gender Any Female Male Diverse or underserved cultural/socioeconomic background Yes a Cultural Linguistic Migrant Indigenous Socioeconomic No a Living arrangements Yes a Own home Public housing complex Retirement village Residential aged care facility No a Physical activity level Yes a Low physical activity No a Physical impairments/limitati

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.