Evidence-based interventions for promoting healthy aging: a scoping review

Abstract

Background

Population aging poses a major demographic challenge, particularly in low- and middle-income countries where chronic and neurocognitive conditions are increasing. The World Health Organization defines healthy ageing as the process of maintaining functional ability through the interaction between intrinsic capacity (physical and mental health) and environmental factors across the life course, emphasizing function rather than disease absence.

Objectives

This scoping review synthesized scientific evidence on interventions that promote healthy ageing across the life course, following the Joanna Briggs Institute PCC framework.

Methods

A comprehensive search was conducted in PubMed, Scielo, EMBASE, PsycINFO, Cochrane, and LILACS without language or date restrictions. From 5,808 records, 219 studies met the inclusion criteria, including systematic reviews, clinical trials, quasi-experimental, and observational studies.

Results

Most interventions focused on physical and mental health in adult and older populations. Multicomponent physical activity, nutritional, and cognitive interventions showed consistent benefits for functional ability and wellbeing, while evidence on life-course, environmental, and policy-level interventions remained limited.

Conclusions

Integrative, multicomponent, and culturally adapted interventions are most effective for promoting healthy ageing. Future research should adopt life-course approaches and prioritize long-term, well-powered studies to inform equitable ageing policies.

1. Introduction

Population aging is one of the most important demographic challenges of the 21 st century. According to the World Health Organization (WHO), by 2050 people over 60 years will represent 22% of the global population [1]. Globally, the number of people living with dementia is projected to triple from 50 million to 152 million by 2050, with nearly 60% of new cases occurring in low- and middle-income countries [2]. Although the proportion of life spent in good health has remained constant, additional years are often associated with declining health status [1], underscoring the need for substantial adaptations in health, economic, and social systems to ensure the integration and care of older adults [1].

The concept of aging has evolved considerably, moving beyond a chronological perspective to a multidimensional understanding grounded in the interaction between individual capacities and contextual determinants. Aging is now viewed as a dynamic and adaptive process shaped by biological, behavioral, social, and environmental factors—including interpersonal relationships, education, nutrition, sociocultural and technological conditions, and both physical and mental health [3]. Within this framework, these domains represent interconnected components of a broader model of change for healthy ageing, in which determinants and processes across sectors (health, social participation, education, technology, nutrition, policy, and culture) influence functional ability and well-being throughout life. Building on this conceptual basis, several theories have sought to explain how experiences accumulated from childhood through adulthood determine trajectories of health and functioning in later life. Moreover, evidence highlights a degree of plasticity that allows for positive modification of outcomes through targeted interventions at any stage of the life course [4].

Healthy aging is defined by the WHO as "the process of developing and maintaining the functional ability that enables well-being in older age" [5]. This concept, formally endorsed in 2016, serves as the foundational framework for the United Nations Decade of Healthy Ageing (2021–2030). The framework emphasizes two core elements: intrinsic capacity—encompassing both physical and mental health—and the environmental factors that interact with it to support autonomy and meaningful participation throughout the life course. Building on this foundation, the WHO recently released an updated framework that adopts a comprehensive life-course approach, explicitly connecting optimal development in early life with functional ability and well-being in older age [6]. This updated perspective integrates and refines existing WHO guidance on evidence-based interventions across different life stages and functional capacities. Importantly, it highlights the continuity between developmental and ageing processes, reinforcing the critical need for policies and interventions that sustain positive health trajectories across the entire lifespan [6,7]. Crucially, the WHO explicitly states that "being free of disease or infirmity is not a requirement for healthy ageing, as many older adults have one or more health conditions that, when well controlled, have little influence on their wellbeing" [7]. This function-centered—rather than disease-centered—approach acknowledges that chronic conditions may influence intrinsic capacity but do not preclude healthy ageing trajectories.

Demographic shifts pose significant challenges for social security systems and care models. Care for older adults continues to fall disproportionately on women, creating a substantial caregiver burden [[8], [9], [10]]. Moreover, persistent gaps in the enforcement of policies aimed at ensuring quality of life and healthy aging highlight the need to strengthen their practical implementation, as these shortcomings reflect social and health vulnerabilities common to many upper-middle-income contexts and reinforce the importance of understanding the factors that promote healthy aging.

Despite advances in identifying predictors such as physical activity, self-care, family and community networks, and health system support, there remains a need to synthesize evidence on effective interventions, including how life experiences influence adaptation to aging [[11], [12], [13]]. To address this, the present study conducts a scoping review of the existing literature to identify evidence-based interventions that promote healthy aging. The research question guiding this review is therefore: What evidence-based interventions have been shown to promote healthy aging in older populations? A scoping review was chosen as the most appropriate design, as it allows for a comprehensive mapping of existing literature, identification of knowledge gaps, and synthesis of a wide range of study types.

2. Methods

The aim of this study was to address this gap through a scoping review to identify actions, interventions, and practices supported by scientific evidence that promote healthy aging. The study protocol was submitted to the Internal Committee of the Department of the Pontificia Xaveriana University in January 2025 and received ethical approval. The review was designed using the PCC framework (Population, Concept, and Context) proposed by the Joanna Briggs Institute, which enables a structured and precise search [9]. The Population considered was the lifespan; the Concept included actions, interventions, and evidence-based practices aimed at promoting healthy aging; and the Context encompassed both urban and rural settings. This scoping review synthesized evidence from studies conducted worldwide without geographic restrictions.

2.1. Search strategy

A search was conducted in January 2025 across multiple databases, including PubMed, Scielo, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (via Ovid), and LILACS.The reference lists of all included sources were screened to identify additional studies. Articles published in Spanish and English were considered, as the research team was fluent in both languages, and no publication date limits were applied.

The initial search was restricted to PubMed to identify key studies and develop a structured search strategy. MeSH and EMTREE terms, along with free-text keywords, were selected from the controlled vocabularies of PubMed, Scielo, EMBASE, and PsycNet. Additional search terms were identified using tools such as PubReMiner and MeSH, as well as from abstracts of relevant articles already known to the authors. Search equations and corresponding results are presented in Table 1.

Table 1.

Search equation strategies.

No.	Database	Search Strategy	Restrictions	Number of Results
1	Pubmed	(("Healthy Aging"[MeSH] OR "Aging"[MeSH] OR "Longevity"[MeSH] OR "healthy aging"[Title/Abstract] OR "aging"[Title/Abstract] OR "aging"[Title/Abstract] OR "healthy aging"[Title/Abstract] OR "aging"[Title/Abstract]) AND ("Health Promotion"[MeSH] OR "Life Style"[MeSH] OR "Social Determinants of Health"[MeSH] OR "Psychosocial Intervention"[MeSH] OR "Social Work"[MeSH] OR "psychosocial intervention"[Title/Abstract] OR "psychological intervention"[Title/Abstract] OR "psychosocial interventions"[Title/Abstract] OR "psychological interventions"[Title/Abstract] OR "interventions"[Title/Abstract] OR "lifestyle"[Title/Abstract]))	Free full text, Clinical trial, meta-analysis, randomized controlled trial, review, sistematic review. English and Spanish	1238
1	Scielo	(ti:(("healthy aging") OR ("aging") AND ("interventions") OR ("lifestyle")))	Spanish and English	232
2	Scielo	(("Healthy Aging"[MeSH] OR "Aging"[MeSH] OR "Longevity"[MeSH] OR "healthy aging"[Title/Abstract] OR "aging"[Title/Abstract] OR "ageing"[Title/Abstract] OR "healthy aging"[Title/Abstract] OR "aging"[Title/Abstract]) AND ("Health Promotion"[MeSH] OR "Life Style"[MeSH] OR "Social Determinants of Health"[MeSH] OR "Psychosocial Intervention"[MeSH] OR "Social Work"[MeSH] OR "psychosocial intervention"[Title/Abstract] OR "psychological intervention"[Title/Abstract] OR "psychosocial interventions"[Title/Abstract] OR "psychological interventions"[Title/Abstract] OR "interventions"[Title/Abstract] OR "lifestyle"[Title/Abstract]))	—	0
1	Embase	('healthy aging'/exp OR 'healthy aging' OR 'aging'/exp OR 'aging' OR 'longevity'/exp OR 'longevity' OR 'healthy aging':ti,ab OR 'aging':ti,ab OR 'ageing':ti,ab OR 'envejecimiento saludable':ti,ab OR 'envejecimiento':ti,ab) AND ('health promotion'/exp OR 'health promotion' OR 'life style'/exp OR 'life style' OR 'social determinants of health'/exp OR 'social determinants of health' OR 'psychosocial intervention'/exp OR 'psychosocial intervention' OR 'social work'/exp OR 'social work' OR 'psychosocial intervention':ti,ab OR 'psychological intervention':ti,ab OR 'intervenciones psicosociales':ti,ab OR 'intervenciones psicológicas':ti,ab OR 'intervenciones':ti,ab OR 'estilo de vida':ti,ab) AND ([cochrane review]/lim OR [systematic review]/lim OR [meta analysis]/lim OR [controlled clinical trial]/lim OR [randomized controlled trial]/lim) AND ([article]/lim OR [review]/lim) AND ([english]/lim OR [spanish]/lim) AND [humans]/lim AND [abstracts]/lim AND ([embase]/lim OR [medline]/lim OR [pubmed-not-medline]/lim)	Study type	1863
1	APA Psycnet	((TI("healthy aging") OR TI("aging") OR TI("ageing") OR TI("envejecimiento saludable") OR TI("envejecimiento") OR AB("healthy aging") OR AB("aging") OR AB("ageing") OR AB("envejecimiento saludable") OR AB("envejecimiento")) AND (TI("health promotion") OR TI("life style") OR TI("social determinants of health") OR TI("psychosocial intervention") OR TI("social work") OR TI("psychological intervention") OR TI("intervenciones psicosociales") OR TI("intervenciones psicológicas") OR TI("intervenciones") OR TI("estilo de vida") OR AB("health promotion") OR AB("life style") OR AB("social determinants of health") OR AB("psychosocial intervention") OR AB("social work") OR AB("psychological intervention") OR AB("intervenciones psicosociales") OR AB("intervenciones psicológicas") OR AB("intervenciones") OR AB("estilo de vida"))) AND (lang: "English" OR lang: "Spanish")	Peer reviewed – Full	1072
1	Cochrane Central Register of Controlled Trials Search Strategy	(("Healthy Aging" OR "Aging" OR "Longevity" OR "healthy aging" OR "aging" OR "ageing" OR "envejecimiento saludable" OR "envejecimiento") AND ("Health Promotion" OR "Life Style" OR "Social Determinants of Health" OR "Psychosocial Intervention" OR "Social Work" OR "psychosocial intervention" OR "psychological intervention" OR "intervenciones psicosociales" OR "intervenciones psicológicas" OR "intervenciones" OR "estilo de vida") AND ("review" OR "systematic review" OR "randomized controlled trial"))	—	112
—	LILACS	(("Healthy Aging" OR "Aging" OR "Longevity" OR "healthy aging" OR "aging" OR "ageing" OR "envejecimiento saludable" OR "envejecimiento") AND ("Health Promotion" OR "Life Style" OR "Social Determinants of Health" OR "Psychosocial Intervention" OR "Social Work" OR "psychosocial intervention" OR "psychological intervention" OR "intervenciones psicosociales" OR "intervenciones psicológicas" OR "intervenciones" OR "estilo de vida"))	Full text in English or Spanish"	1510
—	ProQuest Search Strategy	((TI("healthy aging") OR TI("aging") OR TI("ageing") OR TI("envejecimiento saludable") OR TI("envejecimiento") OR AB("healthy aging") OR AB("aging") OR AB("ageing") OR AB("envejecimiento saludable") OR AB("envejecimiento")) AND (TI("health promotion") OR TI("life style") OR TI("social determinants of health") OR TI("psychosocial intervention") OR TI("social work") OR TI("psychological intervention") OR TI("intervenciones psicosociales") OR TI("intervenciones psicológicas") OR TI("intervenciones") OR TI("estilo de vida") OR AB("health promotion") OR AB("life style") OR AB("social determinants of health") OR AB("psychosocial intervention") OR AB("social work") OR AB("psychological intervention") OR AB("intervenciones psicosociales") OR AB("intervenciones psicológicas") OR AB("intervenciones") OR AB("estilo de vida"))) AND LA(("English" OR "Spanish"))	Peer-reviewed scientific journals, full text in Spanish and English	13

2.2. Inclusion criteria

Quantitative studies evaluating interventions to promote healthy aging, conducted in urban and/or rural settings, were included regardless of the country of origin. Eligible interventions targeted all age groups across the life course. Consistent with the WHO framework, studies were required to report outcomes aligned with functional ability and intrinsic capacity domains—including cognition, locomotion, vitality, psychological wellbeing, and sensory function—as well as quality of life and physical, mental, or social well-being. Only peer-reviewed, full-text articles published in Spanish or English were considered, with no restrictions on publication date.

Conceptual framework alignment: This scoping review adopts a function-centered approach consistent with the WHO framework for healthy ageing. Rather than focusing on disease prevention or management per se, we prioritized interventions evaluated against outcomes related to functional ability, intrinsic capacity, and wellbeing. Studies conducted in populations with prevalent chronic conditions were included when their outcomes pertained to function and capacity rather than disease-specific endpoints, recognizing that the WHO framework explicitly acknowledges that healthy ageing does not require the absence of disease.

2.3. Exclusion criteria

Research protocols, ongoing studies without conclusive results, and those not subjected to peer review were excluded, as the review focused on interventions reporting measurable and comparable outcomes related to healthy aging. Studies exclusively targeting individuals with cognitive impairment, psychotic disorders, or affective disorders were also excluded, as were opinion pieces, editorials, and unpublished theses. Additionally, studies unavailable in full text or lacking sufficient information for analysis were discarded. Qualitative studies were excluded as well, given that the objective of this review was to synthesize evidence based on quantifiable outcomes—such as quality of life, functional capacity, and physical, mental, or social well-being. This decision enabled a structured comparison and categorization of interventions across studies, facilitating the identification of patterns and gaps in the existing evidence

2.4. Data charting, collection, summarization

After completing the literature search, all retrieved citations were uploaded into Rayyan QCRI, which facilitated duplicate removal through its automated detection function. A manual verification was also performed to ensure accuracy.

Prior to the formal selection process, a pilot test was conducted to ensure that reviewers shared a consistent understanding of the inclusion criteria. The selection process was subsequently carried out in two stages: titles and abstracts were independently screened by at least two reviewers according to the eligibility criteria, and articles meeting these criteria underwent full-text evaluation. Reasons for exclusion were documented and reported to maintain transparency in the scoping review.

For each included study, summary tables were created to facilitate analysis and comparison. These tables captured bibliographic details (title, authors, year, country), study type, objectives, main findings, conclusions, funding sources, and assessments of risk of bias and conflicts of interest. Methodological quality observations were also recorded. Each intervention was categorized by age group and detailed according to activity type, duration, location, cultural adaptations, and long-term follow-up. Main outcomes focused on quality of life, functional capacity, and indicators of physical, mental, and social well-being. To synthesize the findings, thematic categories were developed, including primary, secondary, and tertiary domains such as physical health, mental health, social participation, nutrition, technology, environment, education, and public policy. This systematization enabled a structured and comprehensive characterization of the available evidence on healthy aging promotion.

Following article selection, artificial intelligence (ChatGPT Pro with the GPT-4 model) was employed solely as an auxiliary tool to facilitate structured data extraction. Its use was limited to organizing and systematizing information, without any influence on the study results or interpretation. To ensure reliability, a multi-step verification strategy was implemented: two reviewers independently verified a 10% pilot sample (n = 22 studies) to calibrate extraction parameters and confirm reliability; all extracted data were reviewed by the research team during evidence synthesis, with discrepancies resolved through consultation of original sources; and an independent verification of 100 randomly selected studies (46% of included studies) confirmed complete concordance with the original extraction. Studies that did not meet the methodological standards established for this review were excluded. Specific prompts used with ChatGPT are provided in the supplementary materials (Appendix 1).

The entire search and selection process, along with study retrieval and inclusion, is presented in a flow diagram following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines (Fig. 1). This diagram illustrates each stage of the review, including duplicate removal, full-text screening, additional sources, data extraction, and evidence synthesis, ensuring transparency and methodological rigor.

Fig. 1.

PRISMA flow diagram.

3. Results

A total of 5,808 records were identified through searches in scientific databases and grey literature. After removing 823 duplicate records, 4,986 titles and abstracts were screened. Of these, 379 full-text articles were assessed for eligibility. Ultimately, 219 studies met the inclusion criteria and were included in the final review. No additional sources were identified through manual searching or reference list screening.

The included studies comprised a range of methodological designs, including randomized controlled trials, quasi-experimental studies, and observational research, as well as evidence syntheses such as systematic reviews, meta-analyses, and scoping reviews. Across these studies, a broad spectrum of interventions aimed at promoting healthy ageing across different stages of the life course was examined.

The findings were organized into nine thematic categories reflecting the most frequently investigated domains: physical and mental health, social behaviors, education, technology use, public policy and the built environment, religion and spirituality, nutrition, life course perspectives, and other relevant domains. Among the 219 included studies, physical health was the most frequently examined domain (n = 79), followed by mental and emotional health (n = 43). Additional thematic areas included social networks and participation (n = 31), education and development (n = 16), environmental and public policy interventions (n = 15), nutrition (n = 15), technology-based interventions (n = 12), life-course approaches (n = 6), and religion and culture (n = 2).

Most studies focused on adult and older adult populations. The majority of the evidence (n = 206) evaluated interventions among adults aged 60 years and older. A smaller number of studies (n = 7) targeted middle-aged adults (30–59 years), while only six studies specifically addressed interventions during childhood, adolescence, or early adulthood. These findings indicate that most available evidence on interventions for healthy ageing derives from studies conducted in later stages of the life course.

Across study designs, several types of interventions were investigated. Randomized and quasi-experimental studies most frequently evaluated multicomponent physical activity programs, which reported improvements in functional capacity, physical performance, and prevention of disability in ageing populations. Nutritional interventions—particularly those promoting Mediterranean-style dietary patterns—as well as structured cognitive and psychological interventions were also examined in experimental and quasi-experimental studies, with reported improvements in cognitive outcomes, mental health indicators, and overall wellbeing.

Longitudinal and other observational studies contributed additional evidence regarding associations between lifestyle factors and healthy ageing outcomes. In contrast, interventions related to life-course approaches, environmental factors, and policy-level strategies were less frequently represented and were primarily examined through observational designs.

To facilitate the interpretation of findings and address the heterogeneity of study designs across the corpus, results within each thematic category are presented hierarchically according to the strength of evidence. Findings from randomized controlled trials (RCTs) and quasi-experimental studies are prioritized, followed by longitudinal observational studies, and subsequently by cross-sectional investigations. Where relevant, evidence derived from secondary syntheses — including systematic reviews and meta-analyses that were themselves among the 219 included studies — is explicitly distinguished from evidence derived from primary studies. Table 2 presents the distribution of included studies by thematic category and study design.

Table 2.

Distribution of included studies by thematic category and study design (n = 219).

Thematic category	Total studies (n)	Total participants (approx.)	SR / MA (n)	RCTs and quasi-experimental studies		Longitudinal observational studies		Cross-sectional studies
				n studies	N participants (approx.)	n studies	N participants (approx.)	n studies	N participants (approx.)
Life course approach	6	21665	0	0	0	6	21665	0	0
Physical health interventions	78	154037	23	43	13789	12	140248	0	0
Mental and emotional health interventions	43	10374	6	27	6159	10	4215	0	0
Social networks and participation	31	21992	1	11	2805	19	19187	0	0
Education and development	16	13923	2	10	9850	4	4073	0	0
Technology-based interventions	12	1920	6	5	789	1	1131	0	0
Nutrition interventions	15	2392	6	8	2209	1	183	0	0
Environmental and public policy interventions	15	34467	5	4	9094	6	25373	0	0
Religion and culture	2	2196	0	1	64	1	2132	0	0
TOTAL	218	262966	49	109	44759	60	218207	0	0

Abbreviations: SR/MA, systematic review or meta-analysis; RCT, randomized controlled trial; N, number of participants.

SR/MA: secondary syntheses included as evidence sources within the scoping review; these studies aggregate data from primary investigations and do not contribute independent participant counts. Total participants (approx.) reflects the pooled or reported sample size across all primary studies within each design category per thematic area; participant counts from SR/MA are not double-counted where the primary study composition was reported. Studies were classified according to their primary design as declared in the abstract. Where a single publication reported both longitudinal and cross-sectional analyses, classification followed the main study design. Total participants across all thematic categories should be interpreted with caution given potential overlap in study populations across sections.

3.1. Life course approach

A limited number of studies examined interventions or factors related to the life-course perspective on healthy ageing. These studies explored how psychosocial, behavioral, and early-life factors were associated with wellbeing and cognitive outcomes across different stages of life. The studies employed observational designs, including cross-sectional [14,15], longitudinal [[16], [17], [18]], and mixed-cohort analyses [19]. While such designs limit causal inference, they provide valuable strengths, including large population-based samples, probabilistic recruitment, repeated assessments, and validated psychometric instruments.

3.1.1. Observational evidence (cross-sectional and longitudinal studies)

Several observational studies investigated psychosocial determinants of wellbeing across adulthood. Findings indicated that outcomes such as job satisfaction and overall life satisfaction were associated with psychosocial factors including job congruence, locus of control, tenure, and salary [14]. In addition, future-oriented planning was reported to function as a mediator linking education, conscientiousness, perceived control, and life satisfaction [15]. Personality traits were also examined, with evidence suggesting that emotional stability was consistently associated with both global and domain-specific life satisfaction across adulthood [19].

Other studies focused on behavioral and cognitive factors across the lifespan. Physical activity was positively associated with life satisfaction at different ages, with cumulative effects becoming more pronounced during midlife. These associations were partly mediated by physical and mental health indicators [17]. In studies examining age-related differences in mnemonic training outcomes among individuals aged 10–79 years, evidence suggested the presence of cognitive plasticity across the lifespan [16]. Additionally, retrospective assessments indicated that childhood social support was associated with better episodic memory in later life, with this relationship partially mediated by education, stress, and body mass index [18].

3.2. Physical health interventions

The evidence on physical health interventions was synthesized mainly through secondary analyses. In total, the section included 11 systematic reviews, 7 meta-analyses, 1 rapid review, and 1 combined scoping review and meta-analysis. These reviews synthesized different types of primary studies, including randomized controlled trials (RCTs), controlled trials, quasi-experimental studies, and observational designs (cohort, case–control, and cross-sectional). Several reviews specifically summarized RCT evidence (e.g., a rapid review including 87 randomized trials and others including between 7 and 14 RCTs), while some meta-analyses were based on large observational datasets [[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]].

3.2.1. Experimental evidence (RCTs and quasi-experimental studies)

A systematic review of 147 studies (11 609 participants, and network meta-analysis, (including 105 studies, n = 7759 participants), exercise interventions were associated with significantly improved overall physical function, multicomponent programs that combine strength, balance, endurance, and flexibility reported improvements in muscle strength, gait speed, balance, and functional independence among older adults with greater benefits at higher weekly doses [20]. Other systematic review and meta-analysis evaluated dance movement interventions with data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) and found effective in promoting mental health amongst older adults without dementia [21], and physical activity interventions in middle-aged adults improved strength and balance, although maintenance of effects over time was often unclear [22].

A meta-analysis of community-dwelling adults aged 50–80 years (n≈17,000 for incidence; n≈8,500 for progression) evaluated the association between habitual physical activity (PA) and basic activities of daily living (BADL) disability using pooled observational data. Medium-to-high PA levels were associated with lower risk of incident BADL disability (OR 0.51; 95% CI 0.38–0.68) and lower risk of progression (OR 0.55; 95% CI 0.42–0.71). Limitations included substantial heterogeneity and reliance on self-reported PA measures. [23].

A systematic review and meta-analysis of 1,227 adults (mean age 65.4 years) compared high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) across randomized and controlled trials. Both interventions improved VO₂max, body fat percentage, and blood pressure; HIIT showed greater reduction in waist circumference and superior performance on the complex Stroop test. Limitations included short intervention durations and limited controlled data for some outcomes [24].

A systematic review of 10 studies in menopausal women aged 45–75 years (sample sizes 32–5,112) assessed combined physical exercise (resistance training or HIIT) and dietary supplementation (omega-3, calcium, vitamin D). Combined interventions improved muscle mass, muscle strength, and bone mineral density. Limitations included small number of studies and limited data on emerging training modalities [25].

A rapid review of 87 randomized trials (n = 26,861; median age ≥60 years) evaluated structured, multicomponent, and recreational PA programs. Structured and multicomponent exercise reduced falls and improved functional capacity, whereas dance and yoga showed effects on cognitive and emotional outcomes. Limitations included absence of meta-analytic pooling and exclusion of small or lower-quality trials [26].

A meta-analysis of seven studies in adults ≥60 years evaluated dance-based interventions and reported improvements in muscle strength, balance (Berg Balance Scale), and flexibility [27]. A systematic review of 212 adults ≥45 years practicing Olympic combat sports identified moderate effects on physical health-related quality of life [28]. A meta-analysis of 227 older women assessed Taekwondo and found improvements in global cognition (SMD 0.70), β-amyloid and BDNF levels, and depressive symptoms (SMD 1.52); limitations included single-sex samples and lack of blinding [29]. A comprehensive reviews od randomized trials in 275 adults aged 60–80 years reported improvements in health status and mental well-being with yoga [30], and systematic reviews of Tai Chi and Qigong documented gains in balance, strength, and immune markers [31].

A systematic review and meta-analysis of 3,309 employees aged ≥50 years evaluated workplace PA interventions (walking, Tai Chi, resistance training). Pooled effects showed improvements in PA behavior (ES 0.25), muscular strength (ES 0.27), cardiorespiratory fitness (ES 0.28), flexibility (ES 0.50), and balance (ES 0.74). Limitations included high heterogeneity and limited number of strength- or balance-focused trials [32].

A systematic review of 41 studies in healthy older adults, predominantly women ≥60 years, assessed Pilates interventions. Improvements were reported in balance, muscular strength, functional autonomy, and flexibility, particularly in programs ≥12 weeks. Limitations included low methodological quality and lack of protocol standardization [33].

3.2.2. Observational evidence (longitudinal and cross-sectional studies)

A systematic review and meta-analysis of 230,174 adults aged 63–100 years evaluated the association between moderate-to-vigorous PA and sarcopenia in observational studies; each 30-minute daily increase in PA was associated with lower odds of sarcopenia (OR 0.85), while sedentary behavior showed no consistent association [34]. A meta-analysis of cross-sectional and longitudinal associations of three prospective cohorts (n = 24,332) assessed adherence to PA guidelines and biological aging markers, reporting associations with lower MetaboHealth scores. Both analyses were limited by observational design and inability to infer causality [35].

A systematic review including 27 observational cohort studies of adults aged over 80 years aimed to identify lifestyle factors relevant to the prevention of dementia. The review found that adherence to a healthy diet rich in fruits and vegetables, as well as participation in leisure and physical activities, may protect against cognitive decline and cognitive impairment regardless of APOE genotype. The main limitations included substantial heterogeneity in measurement instruments and the use of several self-reported measures [36].

A meta-analysis and scoping review of 38 studies—including randomized controlled trials, cohort studies, case–control studies, and cross-sectional studies—sought to synthesize the available evidence on risk factors and predictors of healthy aging in Latin America. Educational attainment and physical activity were identified as the most common predictors of healthy aging; however, their effects were variable. Additional limitations included heterogeneity in the definitions of healthy aging and inconsistencies in the reported associations across studies [37].

A systematic review included 34 experimental, quasi-experimental, and cohort studies that used music or physical activity as interventions to modulate physiological and cognitive aspects of aging. Most studies reported significant improvements in cognitive functions following exposure to music or physical activity. Prolonged musical training was associated with better performance in verbal and working memory tasks, verbal fluency, and executive functions. Regular physical activity was linked to improvements in episodic memory, attention, and hippocampal volume. Musical interventions also demonstrated effects on mood and quality of life; however, methodological differences across studies hindered direct comparisons, and no quantitative meta-analysis was conducted [38].

Finally, another systematic review included seven randomized controlled trials aimed at evaluating the effectiveness of interventions designed to reduce sedentary behavior in community-dwelling older adults. A potential reduction in sedentary time (approximately 45 min per day) was observed with behavioral interventions, although no consistent changes were found in other outcomes such as blood pressure or obesity. Limitations included the lack of data on adverse effects, cost-effectiveness, or quality of life, as well as high heterogeneity and low statistical power [39].

3.2.3. Evidence from experimental and quasi-experimental studies (synthesized through systematic reviews and meta-analyses)

3.2.3.1. Mental and emotional health interventions

Across this set of studies, the evidence was synthesized primarily through secondary analyses. In total, four systematic reviews and meta-analyses [40,43,44] and two systematic reviews without meta-analysis [42,45] were identified, along with two independent meta-analyses of cognitive training studies [41]. These syntheses incorporated diverse primary study designs, including randomized controlled trials (e.g., 18 RCTs in memory-strategy training interventions), controlled intervention studies and mixed experimental and observational designs.

A systematic review and meta-analysis of memory-strategy training interventions included 18 randomized controlled trials identified from 536 articles, with 15 trials contributing to the meta-analysis. The findings showed that these interventions improved several participant-reported outcomes in healthy older adults with age-related memory changes, including perceived memory ability, memory self-efficacy, strategy use, memory-related affect, psychological well-being, and quality of life [40].

Two meta-analyses including 64 studies (3,594 participants) evaluated computerized cognitive training targeting core executive functions in older adults. The analyses showed large effects on trained tasks and small but significant effects on near-transfer and far-transfer cognitive outcomes, including executive functioning, fluid intelligence, memory, and visuospatial abilities. Improvements were maintained at follow-up, suggesting sustained benefits of cognitive training over time [41].

A systematic review of 73 studies (N = 3,749) evaluated interventions targeting prospective memory in middle-aged and older adults. Four types of interventions were identified: mnemonic strategies, cognitive training, external memory aids, and combination approaches. Overall, mnemonic strategies and cognitive training showed moderate effects, while external memory aids demonstrated the largest improvements in prospective memory performance, although often based on smaller studies. The review also highlighted variability in ecological validity across intervention types and emphasized the need for larger trials to strengthen the evidence base [42].

A systematic review and meta-analysis of 46 controlled studies (23 physical exercise, 21 cognitive training, and 2 combined interventions) compared the effects of physical exercise and cognitive training on executive functions in adults aged ≥65 years. Both interventions showed significant improvements in executive functioning, with larger effect sizes for cognitive training (d = 0.24) compared with physical exercise (d = 0.12). Cognitive training demonstrated particularly stronger effects on problem-solving abilities, while physical exercise showed modest but consistent effects across executive domains [43].A systematic review and meta-analysis including 14 studies evaluated the effects of dance interventions in older adults with mild cognitive impairment. Pooled results showed significant improvements in global cognition, rote memory, immediate and delayed recall, and attention. However, no significant effects were observed for executive function, language, depression, anxiety, motor function, or quality of life [44].

A systematic review including nine studies (total n = 983) evaluated individual psychological interventions in non-clinical older adults. Most studies reported significant improvements in psychological well-being and reductions in depressive symptoms and distress, with effect sizes ranging from trivial to very large, suggesting that individual psychological interventions may benefit mental health in this population [45].

3.3. Social networks and participation

3.3.1. Evidence from quasi-experimental and mixed-design studies (single systematic review)

Evidence regarding social networks and participation derived primarily from a systematic review of intervention studies targeting adults undergoing transition to retirement [46]. The interventions evaluated structured social participation programs designed to promote meaningful social roles, including volunteering in schools, mentoring younger individuals, maintaining public spaces, and engaging in intergenerational support networks. Outcomes assessed included perceived purpose in life, sense of belonging, social contribution, and psychological wellbeing. Participation in structured role-based activities was associated with improvements in self-reported psychosocial outcomes. Programs incorporating financial incentives reported higher participation rates. However, substantial variability in intervention structure, intensity, and delivery limited comparability across studies.

3.4. Education and development

3.4.1. Evidence from experimental and observational studies (synthesized through systematic reviews)

Across these studies, the evidence was synthesized through two secondary analyses: one systematic review and meta-analysis and one comprehensive literature review. One meta-analysis and systematic review examined the effects of non-exercise interventions on quality of life, encompassing a wide range of non-physical strategies such as lifelong learning, leisure activities, art therapy, social support, mindfulness, health education, technology use, occupational workshops, and home visits. The review noted variability in intervention types and durations, along with concerns about risk of bias and sample representativeness [47].

A comprehensive literature review including 22 studies examined health promotion and education programs targeting the aging process. Most studies, primarily quantitative and involving samples of over 100 participants, reported positive outcomes, including improvements in self-perceived physical health, psychosocial well-being, healthy behaviors, physical activity, quality of life, and activities of daily living, although a small number of studies reported minimal or no significant effects [48].

3.5. Technology-based interventions

Across this group of studies on technology-based interventions, the evidence was synthesized through multiple secondary analyses. In total, three systematic reviews and meta-analyses [49,50,53], one umbrella review with meta–meta-analysis covering 22 systematic reviews and meta-analyses and 185 primary studies [51], one independent meta-analysis of 20 experimental studies on video game training [52], and one additional systematic review including 34 studies evaluating digital and telerehabilitation interventions [54] were identified.

3.5.1. Evidence from experimental studies (synthesized through systematic reviews and meta-analyses)

A systematic review and meta-analysis of 18 experimental studies evaluated the effects of eHealth interventions on physical activity among adults over 55 years. The interventions significantly increased daily steps, moderate-to-vigorous physical activity, and total weekly physical activity, indicating that digital health strategies can effectively promote physical activity in older adults [49].

A systematic review and meta-analysis including 22 studies (n = 1,757) evaluated digital behavior change interventions to promote physical activity in adults aged ≥50 years. The results indicated significant increases in total and moderate-to-vigorous physical activity, along with reductions in sedentary time and systolic blood pressure, suggesting that digital interventions may support healthier activity patterns in older adults [50].

An umbrella review and meta–meta-analysis including 22 systematic reviews and meta-analyses (covering 185 primary studies and 28,198 participants) evaluated digital interventions aimed at increasing physical activity in older adults. Overall, the synthesis showed moderate evidence of positive effects on step counts and small but significant improvements in total and moderate-to-vigorous physical activity, suggesting that digital interventions are effective strategies to promote physical activity in this population [51].

A meta-analysis including 20 experimental studies (474 trained participants and 439 controls) examined the effects of video game training on cognitive functioning in healthy older adults. The results showed positive effects on several cognitive domains, including reaction time, attention, memory, and global cognition, supporting the potential of video game–based training as a cognitive enhancement intervention in older age [52].

A systematic review of two studies explored the use of digital health coaching programs for older workers and sedentary adults aged over 50 years in the United States (n = 646). The review found that digital health coaching programs health-related behaviors among older workers; however, these interventions tended to focus primarily on physical aspects, while overlooking social, psychological, and cultural factors associated with aging and retirement. A key limitation was the small number of included studies [53].

In contrast, another systematic review [54] included 34 studies involving healthy older adults and individuals with cognitive impairment, aiming to evaluate intervention patterns and tools delivered through various platforms to address early aging stagnation and disease progression in patients with Parkinson’s disease and dementia. The findings indicated that physical activity and telerehabilitation programs significantly improved quality of life, balance, gait, and motor and cognitive functions in older adults. These interventions were effective in both healthy aging and pathological aging populations. Additionally, the interventions reduced fall risk, enhanced emotional well-being, and promoted functional independence. Socioeconomic benefits included cost savings and improved efficiency in resource utilization. Limitations included limited reporting on individual study populations and potential selection bias.

3.6. Nutrition interventions

Across studies examining nutrition-related interventions and lifestyle factors, the evidence was synthesized through multiple secondary analyses. In total, three systematic reviews and meta-analyses [[55], [56], [57]], one additional meta-analysis of 35 observational studies [58], and two systematic reviews [59,60] were identified. These syntheses incorporated diverse primary study designs, including randomized controlled trials (e.g., eight RCTs evaluating caloric restriction), clinical trials conducted across the life course (47 trials), and large observational datasets assessing dietary exposures such as fish consumption

Evidence regarding nutrition included randomized trials and observational syntheses. A systematic review and meta-analysis on mediterranean-style dietary found patterns (often with olive oil or nuts) associated with small but statistically significant gains in global cognition and memory [55]. One systematic review and meta-analysis in eHealth-based nutritional interventions showed clinically relevant improvements in weight, waist circumference, systolic blood pressure, and HbA1c in middle-aged and older adults [56].

3.6.1. Evidence from randomized controlled trials (synthesized through systematic reviews and meta-analyses)

A systematic review and meta-analysis of eight randomized controlled trials (29 articles; n = 704 participants) evaluated the effects of caloric restriction on health outcomes in healthy aging outcomes in adults. The analysis showed significant reductions in body weight, BMI, fat mass, and total cholesterol, with smaller effects on LDL cholesterol, fasting glucose, and insulin, suggesting that caloric restriction may improve cardiometabolic health [57].

3.6.2. Observational and mixed-design evidence

Evidence on environmental and public policy interventions was comparatively limited (n = 15). Most studies used observational designs and assessed the influence of community-based programmes with a geriatric focus, incorporating multidomain components and environmental, psychosocial, and economic interventions. A meta-analysis of 35 observational studies involving older adults aimed to update the evidence on the association between fish consumption and the risk of cognitive impairment, dementia, and Alzheimer’s disease. The findings indicated that habitual fish consumption is associated with a lower risk of cognitive impairment and cognitive decline in older adults, with a dose–response relationship. However, high heterogeneity across studies was identified as a major limitation [58].

In addition, a systematic review of 47 clinical trials conducted across the life course sought to evaluate the impact of nutrition and lifestyle factors on human longevity and to identify key dietary and lifestyle recommendations. The review found that dietary patterns such as the Mediterranean and Okinawan diets are associated with healthy aging; improvements in overall diet quality are linked to lower all-cause mortality; and supplementation with coenzyme Q10, melatonin, multivitamins, omega-3 fatty acids, and N-acetylcysteine may have beneficial effects. Furthermore, physical activity was shown to reduce sedentary behavior and improve overall well-being, while physical training and mindfulness meditation demonstrated benefits for quality of life as well as immunological and hormonal markers. The main limitations included the lack of large-scale randomized controlled trials and substantial heterogeneity among the included studies [59].

Finally, a systematic review of 34 mixed-methods studies aimed to characterize lifestyle factors and health practices—particularly diet and medication use—among community-dwelling adults aged 95–118 years, in order to identify factors associated with healthy longevity. The review found that greater longevity and lower functional decline were associated with a varied diet, lower salt intake, healthy body weight, low levels of polypharmacy, and good sleep quality. Reported limitations included high heterogeneity and potential underreporting of chronic conditions and medication use [60].

3.7. Environmental and public policy interventions

Evidence on environmental and public policy interventions was comparatively limited (n = 15). Most studies used observational designs and assessed the influence of community-based programmes with a geriatric focus, incorporating multidomain components and environmental, psychosocial, and economic interventions. Community gerontology programmes with multidomain components showed positive effects on functional health, including improved blood pressure control, reduced cognitive decline, and increased long-term care planning [61,62,65,66]. In addition, the inclusion of comprehensive educational activities was associated with improved perceptions of ageing [67]. Community participation was described as a crucial component for sustainable and integrated care systems [68]. Economic incentives were also reported to influence adherence to health promotion and prevention activities, with decreased morbidity and increased physical capacity among women [69].

Regarding environmental interventions, improvements in the quality of transportation and housing were reported to be effective in fostering age-friendly communities and promoting active ageing [64]. Likewise, the neighbourhood environment plays an important role in the health of older adults [70]. It was observed that a greater number of neighbourhood attributes was associated with stronger incentives to engage in physical activity [71,72], and that the use of nature-based spaces may help maintain and enhance functional capacity and well-being through reductions in blood pressure, improvements in mood with decreased stress, and better sleep quality [63].

3.8. Religion and culture

Evidence related to religion and culture included two studies: one evaluating an intervention based on traditional medicine and another examining the relationship between religiosity and health indicators.

Traditional Chinese medicine techniques, evaluated in a clinical trial, were associated with statistically significant improvements in overall quality of life, with higher scores across multiple World Health Organization Quality of Life-OLD domains compared with control participants [73].

An observational study, indicated that organizational religiosity was associated with reduced functional dependence and better comparative self-rated health among older adults. In contrast, non-organizational and intrinsic dimensions of religiosity demonstrated heterogeneous associations, being linked to both improved perceived health and disease burden [74].

Regarding cultural adaptation, only nine of the 219 included studies explicitly reported culturally tailored interventions. These studies were predominantly conducted in high-income settings. Two studies specifically aimed to modify perceptions of healthy ageing through culturally informed approaches and demonstrated cross-cultural potential [67,75]. The remaining studies did not report specific cultural adaptations, although they were conducted across diverse cultural contexts and examined a range of intervention types, including dietary, exercise-based, and social participation interventions.

3.9. Multicomponent interventions

Across domains, a consistent pattern emerged: multicomponent interventions that integrated physical, cognitive, nutritional, psychosocial, and/or technological elements (n = 12) tended to report broader and, in several cases, more sustained effects on functional and health-related outcomes compared to single-domain interventions. For instance, one review showed that combining physical exercise with dietary supplementation produced greater improvements in muscle mass, bone mineral density, and menopausal symptoms than supplementation alone [25]. Similarly, other studies found that multidomain and adaptive executive function training generated greater far-transfer cognitive benefits than single-domain programs [41]. In the digital health field, one systematic review reported stronger effects in multicomponent eHealth nutrition interventions lasting 4–6 months compared with shorter or single-focus approaches [56]. Although not all combined approaches outperformed single-component strategies in every outcome, the overall cross-cutting observation suggests that interventions targeting multiple interrelated determinants of aging are more likely to yield multidimensional benefits. This pattern was evident across physical health, cognitive and mental health, community-based, and technology-supported intervention categories.

Across the included studies, several methodological limitations were recurrently identified. A primary constraint was the substantial heterogeneity in intervention protocols, including variations in content, duration, intensity, and frequency, which limited the comparability of findings across settings. Additionally, many studies relied on self-reported measures of physical activity and well-being, introducing potential reporting bias, while others were characterized by small sample sizes and insufficient long-term follow-up to assess the sustainability of intervention effects. The evidence base also showed a predominance of short-term trials and a heavy reliance on observational designs in life-course and nutritional research, limiting causal inference. Finally, there was a notable underrepresentation of racially diverse populations and participants from low- and middle-income countries, as well as an imbalance between interventions targeting individual intrinsic capacity and those addressing environmental or structural determinants of healthy aging.

4. Discussion

This scoping review provides a comprehensive synthesis of evidence-based interventions that promote healthy ageing across the life course, reinforcing the conceptual shift from disease-centered models toward a functional and multidimensional framework. The findings underscore that healthy ageing is best understood as the cumulative outcome of dynamic interactions among biological, psychological, behavioral, and environmental factors, rather than the absence of pathology. This interpretation aligns with the World Health Organization’s functional ability model, which emphasizes intrinsic capacity and contextual determinants as core components shaping ageing trajectories [6,7]. The patterns identified in the primary studies are broadly consistent with the conclusions of major secondary syntheses on specific intervention modalities, including meta-analyses on multicomponent physical activity, cognitive training, nutritional strategies, and digital health interventions. Where those reviews and meta-analyses were themselves among the 219 included sources, their aggregate findings are reported in the Results section as part of the evidence map; however, the cross-cutting interpretations offered here draw primarily on the primary study evidence and on convergent patterns across domains.

A central interpretation emerging from this synthesis is that interventions targeting multiple domains simultaneously appear to be more effective than those addressing isolated risk factors. This supports ecological and life-course models of ageing, which conceptualize functional ability as the result of interacting systems rather than independent physiological processes. Previous meta-analyses have similarly demonstrated that multidimensional interventions are more likely to produce sustained improvements in functional outcomes compared to single-component strategies, particularly when they integrate behavioral, cognitive, and social elements. These findings suggest that ageing trajectories are modifiable through coordinated interventions that address the complexity of human functioning, reinforcing theoretical frameworks that emphasize adaptability and plasticity throughout adulthood and older age.

The predominance of interventions focused on physical and cognitive domains reflects a longstanding emphasis in ageing research on preserving functional independence and preventing disability. This imbalance limits the development of integrative models capable of linking capacities with the environments that enable or constrain their expression, narrowing the understanding of how structural, behavioral, and cultural factors interact to sustain well-being across time. However, the relatively limited representation of interventions addressing social, environmental, and structural determinants highlights an important gap in the literature. Social participation, environmental accessibility, and supportive institutional contexts are increasingly recognized as essential contributors to healthy ageing, yet remain comparatively understudied.

The findings also reinforce the importance of psychosocial and behavioral determinants across the life course. Evidence suggests that experiences accumulated throughout adulthood—including educational attainment, occupational trajectories, and psychosocial resources—contribute to later-life functional capacity and wellbeing. These observations are consistent with life-course epidemiology, which emphasizes cumulative exposure, critical periods, and pathway effects in shaping ageing outcomes. Interventions that strengthen psychological resilience, cognitive engagement, and social integration may therefore exert long-term protective effects by influencing both intrinsic capacity and adaptive functioning.

Technology-based interventions represent an emerging area with significant potential to enhance accessibility and scalability of healthy ageing strategies. Digital tools may help overcome traditional barriers to intervention delivery, particularly in geographically dispersed or resource-limited settings. However, their effectiveness depends on factors such as usability, digital literacy, and sustained engagement, which vary across populations. These findings are consistent with broader research indicating that technological interventions are most effective when integrated into comprehensive care models rather than implemented as standalone solutions. Future research should prioritize culturally adapted digital strategies and evaluate their long-term effectiveness and equity implications.

The limited representation of early-life and midlife interventions represents a critical gap in the current evidence base. Although theoretical frameworks consistently emphasize the importance of early determinants, most interventions remain concentrated in older populations. This discrepancy suggests a misalignment between conceptual models and empirical research priorities. Addressing this gap is essential to fully operationalize life-course approaches and shift ageing promotion from reactive to preventive paradigms. Longitudinal and interventional studies targeting younger populations are needed to identify optimal timing, mechanisms, and sustained impacts of early preventive strategies.

These findings have important implications for clinical practice, public health policy, and health systems planning. From a clinical perspective, the results support integrated approaches that address physical, cognitive, and psychosocial domains simultaneously, rather than focusing on isolated conditions. From a policy perspective, the evidence highlights the importance of designing multisectoral strategies that incorporate education, social participation, environmental accessibility, and technological innovation. Health systems must move beyond disease management models toward function-oriented care frameworks that prioritize autonomy, participation, and wellbeing. This is particularly relevant for low- and middle-income countries, where demographic transitions are occurring rapidly and health systems must adapt to increasing longevity.

This review also highlights several priorities for future research. There is a need for longitudinal and experimental studies that evaluate the long-term sustainability of intervention effects and their impact on functional ability across different populations. Greater attention should be given to interventions addressing structural and environmental determinants, as well as culturally adapted strategies suitable for diverse contexts. Research should also explore mechanisms underlying intervention effectiveness, including biological, psychological, and social pathways, to inform more targeted and efficient strategies. Additionally, future studies should incorporate standardized outcome measures aligned with the WHO healthy ageing framework to improve comparability and facilitate evidence synthesis.

5. Conclusions and implications

Such efforts are crucial for advancing beyond proof-of-concept efficacy and toward tailored, equitable strategies that reflect the heterogeneity of aging trajectories, ultimately guiding the development of comprehensive, evidence-informed policies and interventions for healthy aging. Nonetheless, to enhance the applicability of findings to real-world settings, future research should prioritize methodologically rigorous primary studies with standardized outcomes, diverse populations, and context-specific implementation strategies. This would strengthen the translational potential of evidence into effective, equitable interventions for healthy ageing across varied sociocultural and health system contexts, and included investigation to embrace disaggregated analyses by race, age, and genetic markers to clarify differential effects and mechanisms of benefit.

To translate existing evidence into public health action, policymakers should prioritize the implementation of multicomponent interventions that go beyond addressing physical and cognitive health to also include social participation, education, nutrition, and environmental support. These programs must be culturally adapted, accessible across socioeconomic strata, and embedded within community infrastructure to ensure sustainability and equity. It is essential to shift away from a disease-centered model and instead emphasize health promotion, prevention, and the strengthening of community-based strategies that foster autonomy and social inclusion. Moreover, these efforts should not be limited to adults and older adults, but integrated from early life stages through a life-course approach that builds the foundations for healthy aging from childhood onwards. Incorporating older adults and caregivers in the design of these interventions is also crucial to enhance their relevance and adoption. Finally, investing in cross-sectoral collaboration between health, social, and educational systems will be key to fostering healthy aging across the life course.

ORCID ID

Anamaría Gómez Díaz: 0000-0002-7821-4506

María Alejandra Jaimes 0000-0003-4601-6246

CRediT authorship contribution statement

Conceptualization and methodology were carried out by González L and Mojica L. Data curation was performed by Mojica L, Riveros S, Zamora V, Gómez A, Otero M, Chaves F, Jaimes M, López V, Ramírez L, and Sánchez V. Formal analysis and interpretation were conducted by all authors, who also contributed to the drafting and visualization of the manuscript, as well as its critical revision to ensure the quality and relevance of the intellectual content.

Declaration of Generative AI and AI-assisted technologies in the writing process

Artificial intelligence (ChatGPT, OpenAI) was used exclusively to assist in extracting key data from the included studies after article selection. The tool was not employed to generate original content or interpret findings. To ensure reliability, a multi-step verification strategy was implemented: two reviewers independently verified a 10% pilot sample (n = 22 studies) to calibrate extraction parameters and confirm reliability; all extracted data were reviewed by the research team during evidence synthesis, with discrepancies resolved through consultation of original sources; and an independent verification of 100 randomly selected studies (46% of included studies) confirmed complete concordance with the original extraction.

Funding sources

This work did not receive any external funding; it was conducted using the researchers' personal resources.

Data statement

The data supporting the findings of this study are available within the article and its supplementary materials (appendices). Additional information can be provided by the corresponding author upon reasonable request.

Declaration of competing interest

No conflicts of interest were reported by the authors concerning the research, writing, or publication of this work.

Appendix A. Supplementary data

The following are Supplementary data to this article: