Improving the Evidence Base for Utilising Mobile app Interventions to Increase Physical Activity in Older Adults.

Primary Supervisor: Professor Simon Griffin

Other members of the supervisory team: Dr Dharani Yerrakalva

Project Outline

Physical activity (PA) is a key factor  in healthy ageing.[1] Physical inactivity is associated with 1 in 6 deaths in the UK and is estimated to cost the UK £7.4 billion annually.[2] If an intervention could encourage just 10 mins/day extra brisk walking, this could lead to a lower risk of dementia and cancer, cardiovascular disease and 16% reduction in premature death [3].   Though interventions have been developed to increase PA[4,5],  sustained changes beyond 12 months have rarely been achieved in older adults. Traditional professional-led interventions have largely failed to produce long-term changes in physical behaviours.  Further, PA trials rarely have representation of older adults. Though UK NICE guidelines currently recommend the delivery of brief physical activity advice within primary care settings, this does not take into account clinician’s ’time to treat’. Johansen et al. [6] predict that implementation of the NICE physical activity guideline would require 15% (167 of 1128 h) of the GP’s yearly total face-to-face time with patients, which is unlikely to be feasible.

Mobile apps are emerging as a potential adjunct/alternative that could offer a scalable solution. Apps have the potential to be more cost-effective[7] and reach more individuals, as smartphone access is high across all socioeconomic groups.[8] Smartphone use is increasing among older adults (70% of >65 years old)[9] and older adults have been shown to engage with health apps for >3 months across different medical settings[10]. However, apps typically have a limited evidence-base among older adults according to findings from the NIHR Older People and Frailty Policy Research Unit[11,12]. Older adults are more at risk of digital exclusion, and where design of app interventions has not taken this into consideration, this could widen health disparities.

Currently, the evidence base for the use of scalable mhealth PA interventions in older adults is limited in several ways. Firstly, it is unclear what the barriers and facilitators are to PA app use in older adults given that older adults have been neglected in this area so far[13,14]. Understanding this will aid design of interventions which will function in real-world settings. Secondly, there is lack of evidence of effectiveness of PA app interventions in older adults. Finally, there is a lack of data on uptake and adherence rates of PA app interventions in older adults. The student will seek to address these gaps in knowledge through three work packages. 

Project Plan

The student will undertake three work packages as follows to answer the gaps outlined above:

1. Undertake a systematic review of barriers and facilitations for use of PA app interventions in older adults
2. Undertake a systematic review and meta-analysis examining effectiveness of         Mhealth PA interventions in older adults. The review will focus on examining whether trials/interventions have taken into account the spectrum of older adults/EDI/digital exclusion in all aspect of design in order to improve effectiveness and whether this has had any impact.
3. Utilise data collected in the AGiLiTY pilot trial (Integrating a digitalised physical activity intervention into routine primary care services: Pilot feasibility study assessing the effectiveness of NHS Active 10 App for inactive middle-aged and older adults in NHS health checks) to:

a. describe uptake and adherence to the NHS Active 10 walking app

b. undertake a process evaluation assessing the implementation of the Active 10 intervention, the mechanisms of impact, and identifying contextual factors influencing engagement.

Main Methods to be Used:

• Systematic review and meta-analysis
• Qualitative analysis (thematic analysis)
• Trial data analysis

Key References