Introduction
The increase in global population of older adults, particularly in low- and middle-income countries, is accompanied by challenges such as decreased quality of life (QoL), social isolation, and declined well-being, necessitating novel interventions. Exercise plays a critical role in improving the physical and psychological health of older adults; however, access to such interventions is limited in some countries. In this context, web-based interventions have emerged as an accessible and low-cost method that can provide the physical and psychological benefits of physical activity to older adults. This systematic review aims to comprehensively examine the effects of web-based physical activity interventions on three key outcomes: QoL, social isolation, and psychological well-being of older adults. Furthermore, it seeks to identify the factors influencing the effectiveness of these interventions and highlight research gaps to guide future studies.
Materials and Methods
This systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was performed in three databases—PubMed, Scopus, and Web of Science—for articles published in English up to July 1, 2024. Based on the PICO framework, the studies that included community-dwelling older adults without significant illnesses (Population), used online or web-based tools (Intervention), with or without a control group (Comparison), and randomized or observational longitudinal studies measuring outcomes such as QoL, psychological well-being, or social isolation (Outcome) were included. The studies on hospitalized elderly, children, individuals with specific illnesses, or unclear outcomes were excluded from the review. Extracted data included author details, year of publication, country, sample size, type of intervention, and measured outcomes. Data were analyzed using narrative synthesis. Due to the diversity in intervention designs and the limited number of studies per category, no meta-analysis was conducted.
Results
In total, 13 studies were included after screening 579 articles. Data analysis revealed varying effects of web-based physical activity interventions on older adults’ quality of life, social isolation, and psychological well-being. Some studies, such as McKeon [26] and Granet [30], reported improvements or maintenance of QoL, while others, such as da Silva [24], found a significant decline, potentially influenced by the COVID-19 pandemic. In addition, different studies employed diverse measures to evaluate the QoL, leading to heterogeneity in results. Web-based physical activity interventions showed modest to moderate effects on reducing social isolation. Studies by Zengin [29] and Baez [21] reported significant reductions in perceived loneliness, while others such as Loveys [23] and Steinman [32] showed minimal or unreasonable changes. These findings suggest that the design and structure of interventions should focus on enhancing effective social interactions. The results also indicated that web-based physical activity interventions could positively affect psychological well-being of older adults. For instance, Danieli [25] demonstrated that combining physical activity with cognitive-behavioral therapy led to significant reductions in stress, depression, and psychological distress. However, the effects of other interventions were limited or temporary. Overall, this review study highlighted the influence of variations in intervention design, duration, and the characteristics of target populations on the effectiveness of web-based physical activity interventions. It underscores the need for controlled clinical trials with longer follow-up periods to better assess the interventions’ efficacy.
Conclusion
Findings from this systematic review study demonstrated that web-based physical activity interventions can improve the QoL and psychological well-being of older adults, but their effectiveness in reducing social isolation remains limited and highly dependent on intervention design. One notable issue was the heterogeneity in intervention structures and outcome measures, resulting in varied findings. Moreover, broader socio-economic factors, such as the COVID-19 pandemic, played a critical role in reducing interactions and intervention effectiveness. These findings highlight the importance of developing hybrid interventions that combine in-person and online support, especially for low-income communities. The use of advanced technologies such as artificial intelligence, integrated with psychological interventions, can further enhance the outcomes of physical activity interventions. Further long-term and controlled clinical trials are recommended to provide more comprehensive information in this field.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this study. This is a systematic review study. No experiments were conducted on human or animal samples. Accordingly, there was no need for an ethical code.
Funding
This article was extracted from thesis of Mohsen Sahranavard, funded by Tarbiat Modares University.
Authors' contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.
Conflicts of interest
The authors declare no conflicts of interest.
References
- WHO. Ageing and health. Geneva: World Health Organization; 2024. [Link]
- Paralikas T, Maria M, Dimitrios T, Christina B, Nikolaos C, Antigoni F, et al. Physical and mental health level of the elderly living in Central Greece. Materia Socio-Medica. 2021; 33(1):16-20. [DOI:10.5455/msm.2021.33.16-20] [PMID]
- Brame J, Kohl J, Centner C, Wurst R, Fuchs R, Tinsel I, et al. Effects of a web-based lifestyle intervention on physical fitness and health in physically inactive adults: A randomized controlled trial. Healthcare. 2023; 11(21):2847. [DOI:10.3390/healthcare11212847] [PMID]
- Psarrou A, Adamakidou T, Apostolara P, Koreli A, Drakopoulou M, Plakas S, et al. Associations between physical activity and health-related quality of life among community-dwelling older adults: A cross-sectional study in urban Greece. Geriatrics. 2023; 8(3):61. [DOI:10.3390/geriatrics8030061] [PMID]
- Cai T, Verze P, Bjerklund Johansen TE. The quality of life definition: Where are we going? Uro. 2021; 1(1):14-22. [DOI:10.3390/uro1010003]
- Yang Q, Tang Y, Jennings G, Zhao B, Zhu F, Ma X. Physical activity and subjective well-being of older adults during COVID-19 prevention and control normalization: Mediating role of outdoor exercise environment and regulating role of exercise form. Frontiers in Psychology. 2022; 13:1014967. [DOI:10.3389/fpsyg.2022.1014967] [PMID]
- Sharifian Sani M, Zanjari N. [Well-being as a multidimensional concept: in search of different concepts and definitions (Persian)]. Social Welfare Quarterly. 2014; 14(52):65-91. [Link]
- Fiorilli G, Buonsenso A, Centorbi M, Calcagno G, Iuliano E, Angiolillo A, et al. Long term physical activity improves quality of life perception, healthy nutrition, and daily life management in elderly: A randomized controlled trial. Nutrients. 2022; 14(12):2527. [DOI:10.3390/nu14122527] [PMID]
- Wei L, Hu Y, Tao Y, Hu R, Zhang L. The effects of physical exercise on the quality of life of healthy older adults in China: A systematic review. Frontiers in Psychology. 2022; 13:895373. [DOI:10.3389/fpsyg.2022.895373] [PMID]
- Hudson J, Zarling A, Ungar R, Albright L, Tkatch R, Russell D, et al. Older adults' experiences in a web-based intervention for loneliness. Gerontology and Geriatric Medicine. 2023; 9:23337214231163004. [DOI:10.1177/23337214231163004] [PMID]
- Ahn J, Falk EB, Kang Y. Relationships between physical activity and loneliness: A systematic review of intervention studies. Current Research in Behavioral Sciences. 2023; 6:100141. [DOI:10.1016/j.crbeha.2023.100141]
- Sunarti S, Subagyo KAH, Haryanti T, Rudijanto A, Ratnawati R, Soeharto S, et al. The effect of physical activity on social isolation in elderly. Acta Medica Indonesiana. 2021; 53(4):423-31. [PMID]
- Peng R, Chang J, Du Y, Zhang C, Li X, Guo Y, et al. Older adults' perceptions and experiences of engaging in web- and mobile-based physical activity interventions: A systematic review and qualitative meta-synthesis. Geriatric Nursing. 2024; 59:630-8. [DOI:10.1016/j.gerinurse.2024.08.025] [PMID]
- Mouton A, Cloes M. Web-based interventions to promote physical activity by older adults: Promising perspectives for a public health challenge. Archives of Public Health. 2013; 71(1):16. [DOI:10.1186/0778-7367-71-16] [PMID]
- Muellmann S, Buck C, Voelcker-Rehage C, Bragina I, Lippke S, Meyer J, et al. Effects of two web-based interventions promoting physical activity among older adults compared to a delayed intervention control group in Northwestern Germany: Results of the PROMOTE community-based intervention trial. Preventive Medicine Reports. 2019; 15:100958. [DOI:10.1016/j.pmedr.2019.100958] [PMID]
- Nikitina S, Didino D, Baez M, Casati F. Feasibility of virtual tablet-based group exercise among older adults in Siberia: findings from two pilot trials. JMIR mHealth uHealth. 2018; 6(2):e7531. [DOI:10.2196/mhealth.7531] [PMID]
- Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine. 2009; 151(4):264-9, W64. [DOI:10.7326/0003-4819-151-4-200908180-00135] [PMID]
- Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making. 2007; 7:16. [DOI:10.1186/1472-6947-7-16] [PMID]
- Lisy K, Porritt K. Narrative synthesis: Considerations and challenges. International Journal of Evidence-Based Healthcare. 2016; 14(4):201. [DOI:10.1097/01.XEB.0000511348.97198.8c]
- Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. 2006. [Link]
- Baez M, Khaghani Far I, Ibarra F, Ferron M, Didino D, Casati F. Effects of online group exercises for older adults on physical, psychological and social wellbeing: A randomized pilot trial. PeerJ. 2017; 5:e3150.[DOI:10.7717/peerj.3150] [PMID]
- Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, et al. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: The e-coacher rct. Health Technology Assessment. 2020; 24(63):1-105. [DOI:10.3310/hta24630]
- Loveys K, Sagar M, Pickering I, Broadbent E. A digital human for delivering a remote loneliness and stress intervention to at-risk younger and older adults during the COVID-19 pandemic: Randomized pilot trial. JMIR Mental Health. 2021; 8(11):e31586. [DOI:10.2196/31586] [PMID]
- da Silva WA, Martins VF, Haas AN, Gonçalves AK. Online exercise training program for Brazilian older adults: Effects on physical fitness and health-related variables of a feasibility study in times of COVID-19. International Journal of Environmental Research and Public Health. 2022; 19(21):14042. [DOI:10.3390/ijerph192114042] [PMID]
- Danieli M, Ciulli T, Mousavi SM, Silvestri G, Barbato S, Di Natale L, et al. Assessing the impact of conversational artificial intelligence in the treatment of stress and anxiety in aging adults: Randomized controlled trial. JMIR Mental Health. 2022; 9(9):e38067. [DOI:10.2196/38067] [PMID]
- McKeon G, Tiedemann A, Sherrington C, Teasdale S, Mastrogiovanni C, Wells R, et al. Feasibility of an online, mental health-informed lifestyle program for people aged 60+ years during the COVID-19 pandemic. Health Promotion Journal of Australia. 2022; 33(3):545-52. [DOI:10.1002/hpja.538] [PMID]
- Recio-Rodríguez JI, Gonzalez-Sanchez S, Tamayo-Morales O, Gómez-Marcos MA, Garcia-Ortiz L, Niño-Martín V, et al. Changes in lifestyles, cognitive impairment, quality of life and activity day living after combined use of smartphone and smartband technology: A randomized clinical trial (EVIDENT-Age study). BMC Geriatrics. 2022; 22(1):782. [DOI:10.1186/s12877-022-03487-5] [PMID]
- Roberts JS, Ferber RA, Funk CN, Harrington AW, Maixner SM, Porte JL, et al. Mood lifters for seniors: Development and evaluation of an online, peer-led mental health program for older adults. Gerontology and Geriatric Medicine. 2022; 8:23337214221117431. [DOI:10.1177/23337214221117431] [PMID]
- Zengin Alpozgen A, Kardes K, Acikbas E, Demirhan F, Sagir K, Avcil E. The effectiveness of synchronous tele-exercise to maintain the physical fitness, quality of life, and mood of older people - a randomized and controlled study. European Geriatric Medicine. 2022; 13(5):1177-85. [DOI:10.1007/s41999-022-00672-y] [PMID]
- Granet J, Peyrusqué E, Ruiz F, Buckinx F, Abdelkader LB, Dang-Vu TT, et al. Web-based physical activity interventions are feasible and beneficial solutions to prevent physical and mental health declines in community-dwelling older adults during isolation periods. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences,. 2023; 78(3):535-44. [DOI:10.1093/gerona/glac127] [PMID]
- Hansen RK, Jochum E, Egholm D, Villumsen M, Hirata RP. Moving together - benefits of an online dance program on physical and mental health for older women: An exploratory mixed-method study. BMC Geriatrics. 2024; 24(1):392. [DOI:10.1186/s12877-024-04983-6] [PMID]
- Steinman L, Chadwick K, Chavez Santos E, Sravanam S, Johnson SS, Rensema E, et al. Remote evidence-based programs for health promotion to support older adults during the COVID-19 pandemic and beyond: mixed methods outcome evaluation. JMIR Aging. 2024; 7:e52069. [DOI:10.2196/52069] [PMID]
- Iovino P, Vellone E, Cedrone N, Riegel B. A middle-range theory of social isolation in chronic illness. International Journal of Environmental Research and Public Health. 2023; 20(6):4940. [DOI:10.3390/ijerph20064940] [PMID]
- Kasi KK. The theory of social isolation by William Julius Wilson [Internet]. 2024. Available from: [Link]
- Seifert TA. The Ryff Scales of psychological well-being [Internet]. 2005. Available from: [Link]
- Ryff CD, Singer B. Psychological well-being: Meaning, measurement, and implications for psychotherapy research. Psychotherapy and Psychosomatics. 1996; 65(1):14-23. [DOI:10.1159/000289026] [PMID]
- Costa DSJ, Mercieca-Bebber R, Rutherford C, Tait MA, King MT. How is quality of life defined and assessed in published research? Quality of Life Research. 2021; 30(8):2109-21. [DOI:10.1007/s11136-021-02826-0] [PMID]
- Luo B, Lau RYK, Li C, Si YW. A critical review of state-of-the-art chatbot designs and applications. WIREs Data Mining and Knowledge Discovery. 2022; 12(1):e1434. [DOI:10.1002/widm.1434]
- Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews. 2022; 18(2):e1230. [DOI:10.1002/cl2.1230] [PMID]