Table 2.
Details of included studies.
| Author, date | Aim of study | Study design | Participants | Context | Relevance 1-3 * | Size | Enablers | Barriers |
|---|---|---|---|---|---|---|---|---|
| Reviews: strength and balance activities | ||||||||
| Burton 2017 | To identify motivators and barriers to older people participating in resistance training. | Systematic review | Older people (Mean age 69.9) | Resistance training | 3 | 14 studies | 92 motivators including: - preventing deterioration (disability), - reducing risk of falls, - building (toning) muscles, - feeling more alert - better concentration. | 24 barriers including - Looking too muscular -thinking participation increased the risk of having a heart attack, stroke, or death |
| Franco 2015 | To identify and synthesise the range of barriers and facilitators to physical activity participation | Systematic review of qualitative | Older people (60-89 years) | General PA (including structured exercise programmes which contain strength and balance activity) | 2 | 132 studies | - social influences - valuing interaction with peers - encouragement from others - personal benefits of physical activity - strength, balance and flexibility - self-confidence - independence - improved health and mental well-being - motivation and beliefs - maintaining habits | - social awkwardness - dependence on professional instruction - physical limitations - pain or discomfort - concerns about falling - comorbidities - competing priorities - access difficulties - environmental barriers,- affordability - apathy- irrelevance - inefficacy |
| Freiberger 2016 | To give recommendations to overcome barriers in the recruitment process and how to increase adherence of frail older persons in exercise programmes. | Ad hoc review of reviews | Frail older people (age not stated) | Exercise programmes for frailty including professional barriers | 2 | Not clear | - attitude, expectations and - expectation fulfilment | - Older people do not consider themselves at risk of falling - overestimation of the effort required - fear of falling - recruitment poor due to low GP understanding - lack of GP funding and involvement in studies - challenges of recruitment |
| Reviews: falls prevention | ||||||||
| Bunn 2008 | To investigate perceptions of facilitators and barriers to participation in falls-prevention interventions | Systematic review | Older people 55+ in falls prevention programmes | Falls prevention programmes | 3 | 24 studies | - social support - low intensity exercise, - greater education, - involvement in decision-making - perception of the programmes as relevant and life-enhancing | - fatalism - denial - under-estimation of the risk of falling - poor self-efficacy - no previous history of exercise - fear of falling - poor health and functional ability - low health expectations - stigma |
| McInnes 2004 | To review older people’s views and experiences of falls prevention | Systematic review | Older people (age 50-97) | falls prevention programmes | 3 | 24 studies | - appropriate information - social aspects - peer support/partnering - identified change characteristics - countering negative beliefs - low-moderate intensity | - lack of non-English information - unfamiliar with ‘falls prevention’ - inaccessible information - social stigma - low health expectations/confidence - differing personal/professional agendas - pain effort and age - emphasis on balance and strength aspects of the programme rather than social - fear of falling |
| Sandlund et al 2017 | To systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people’s views or preferences regarding uptake and adherence to exercise to prevent falls. | Systematic mixed studies review | Older people | Exercise to prevent falls | 3 | 25 studies | - support from professionals or family -social interaction -perceived benefits -a supportive exercise context - feelings of commitment - having fun. | practical issues concerns about exercise - unawareness -reduced health status - lack of support -lack of interest. |
| Yardley et al 2007 | To develop recommendations for promoting uptake of and adherence to falls-prevention interventions among older people | Expert consensus based on reviews | Falls prevention experts | Generation of expert recommendations based on review level evidence | 2 | >100 experts | - perception of benefits - general health mobility and independence - invitation from a health professional - practical support | - falls seen as inevitable consequence of ageing - belief that falls prevention involves unwanted activity restriction to reduce risk- low awareness of benefits - belief suitable only for old, frail or anxious people at high risk of falling- concern about social disapproval |
| Stevens 2010 | To provide information about older adults’ perceptions and beliefs about falls and fall prevention | Qualitative review | Older people (65+) | General review of falls prevention strategies including views | 1 | Not stated | - Belief programme will improve quality of life - relevance - low-intensity exercise - invitation from health professional - involvement in decision making - social support | - fatalism - denial of fall risk - poor self-efficacy - no history of exercise - fear of falling - poor health/function- low health expectations - stigma of programmes for older adults |
| Primary studies: strength and balance | ||||||||
| Bethancourt 2013 | To better understand the barriers to and facilitators of PA and participation in PA programmes among older adults | Qualitative | Random adults aged 66-78 | Medicare members who use a specific PA programme inlcuding strength and balance | 1 | N=52 | - motivation to maintain physical and mental health - access to affordable, convenient, and stimulating PA options | - physical limitations due to health or age; - lack of professional guidance - inadequate information |
| Guess 2012 | To examine the views and attitudes towards aerobic and resistance exercise amongst overweight and obese individuals engaged in a weight management clinic. | Qualitative | Obese adults age mean 40.7 | Weight management clinic | 1 | N=30 | - weight loss | - failure to lose weight reduces motivation to continue - resistance exercise as a masculine activity |
| Halvarsson 2016 | To explore how older women with osteoporosis perceive fall-related concerns and balance in daily life after having participated in balance training | Qualitative | 19 women (66-84 years), with osteoporosis | 1 | N=19 | - Empowerment - Self-efficacy - Daily independence | - Internalized risk perception related to experience of bodily fragility - safety - feeling at risk | |
| Petrescu-Prahova 2016 | To examine facilitators and barriers to the implementation and maintenance of Enhance®Fitness (EF), a group exercise programme for older adults | Qualitative | Instructors, staff members, and master trainers NB. these are intermediaries not the target audience | YMCA group exercise programme | 1 | N=32 | - identifying parts of the programme that can be adapted - hiring staff and instructors that understand and support the -educating staff and instructors about the importance of evidence-based programmes and of data collection for programme evaluation | - support and infrastructure - champions, and funding to cover the costs of programme delivery |
| Simmonds 2015 | To explore the acceptability of high-impact physical activity for increasing bone strength in later life. | Qualitative | Active men and women 50+ | Community, SW England | 1 | N=31 | - the need to understand clear tangible benefits - incorporation of activity into everyday habits. - Older adults were interested how high-impact physical activity would help to maintain their mobility, independence or social relationships. - Some wanted tangible feedback from accelerometers, health care professionals and/ or bone scans in order to develop a more intimate knowledge of their bone health. | - conceptualising bone, - damage to joints falling/safety concerns. |
| Meyer et al 2016 | To identify barriers and opportunities facing community health physiotherapists in delivering a home-based balance exercise programme to address mild balance dysfunction; to understand the perspectives of older people in adopting this programme. | Qualitative | 9 older people and 5 physiothrapists aged 73-86 | community health physiotherapists delivering a home-based balance exercise program | 2 | N=9 | - understanding benefits of specific exercises - enhancing independence - home setting - acceptable design and implementation feasibility - convenience, practicality, and safety - programme design - use of proactive health messages - solid evidence base | - recruitment of people with specific need for balance exercises |
| Lindelof et al 2017 | To describe the views and experiences of participation in a high-intensity functional exercise (HIFE) programme among older people with dementia in nursing homes. | Qualitative | people aged 71-96 | older people with dementia in nursing homes. | 2 | N=21 | - Exercise is challenging but achievable; -Exercise gives pleasure and strength; - Exercise evokes body memories; - Togetherness gives comfort, joy, and encouragement | - not studied |
| Primary studies: Falls prevention | ||||||||
| Yardley 2006 | To identify factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. | Qualitative interviews | Older people in 6 European countries | Falls prevention | 2 | N=69 | -interest and enjoyment -improved health, mood, and independence - personal invitation from a health practitioner -social approval from family and friends. | - denial of falling risk -the belief that no additional falls prevention measures were necessary -practical barriers to attendance at groups (e.g., transport, effort, and cost) - a dislike of group activities |
| Horne et al 2014 | To explore the beliefs of community-dwelling South Asian and White British older adults aged 60 to 70 about falls and exercise for fall prevention | Qualitative | South Asian and White British older adults aged 60 to 70 | Commuinty | 2 | 15 focus groups (n = 87) and 40 in-depth interviews. | - belief that exercise offered actual and potential benefits to the older adult’s personal health - ‘use it or lose it’ - experience of falls (acting as a motivator) | - not considering falls as a serious health issue - belief in need for cautiousness when being active rather than about exercising to prevent falls - belief that exercise was only needed after a fall - experience of falls (acting as a barrier) - lack of knowledge and understanding of the potential benefits of exercise for preventing falls - belief falls were outside their control |
*
This a subjective score combining the quality and scope of the study with its likely ability to help answer the review question