A Systematic Review of the Effects of Therapeutic Exercise With Psychological Interventions on Disability and Personal Outcomes in Older Adults.

The 38 trials differed so much in who they studied, what exercise they gave, which psychological treatment they used and how long it ran that the authors could not pool the results or say how certain the evidence is. Over half of the trials reported nothing about adverse events or dropouts, so harms are largely unknown. Nine of the 38 trials were judged to raise some concern about bias and 1 raised high concern, mostly because the people assessing outcomes knew which treatment each participant had received and because randomisation methods were poorly described. Many trials were small (the smallest had 43 participants), and small studies tend to overstate how well a treatment works. The review captures only the outcomes that came out statistically significant and gives no information on whether those differences were large enough to matter to a patient. Trials in nursing homes and other institutional settings were excluded, as were people with dementia, so the findings say nothing about those groups. The results do not apply to exercise programmes paired with behaviour change techniques such as goal setting or problem solving on their own, only to programmes with a full psychological intervention. The authors could not obtain missing information for 3 trials despite contacting the authors and checking a trial registry.

The authors declare no conflicts of interest. The supplied article does not state who funded the review.

Many of these trials compared the combined intervention with usual care or with an education session rather than with exercise alone, so a positive result does not show that the psychological component added anything beyond the exercise, the extra attention or the extra contact. Do not read this as evidence that adding CBT or motivational interviewing makes older adults stronger or better walkers. On activity outcomes such as walking, balance and mobility most trials found no difference between groups, and the review reports no information on whether the differences that were found were big enough to matter to patients.