The Effect of Lifestyle Interventions on the International Classification of Functioning, Disability and Health Participation Domain in Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) recognizes participation in life situations as a major component of health. Identifying interventions that target this component is critical, particularly in older adulthood, where declines in physical functioning can impact participation. The purpose of this study was to evaluate the effectiveness of lifestyle or behavior change interventions on the ICF participation domain in older adults. RESEARCH DESIGN AND METHODS: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), AgeLine (EBSCO), PsycINFO (Ovid), and AMED (Ovid) were searched from inception to April 2020 for randomized controlled trials comparing the effects of any behavior change or lifestyle intervention to usual care among community-dwelling adults ≥60 years with respect to participation-related domains of the ICF. The protocol was registered with Prospero (CRD42019125334). RESULTS: Eight studies with a total of 1,548 participants were included. No significant effect on participation outcomes was found (standardized mean difference 0.04; 95% CI -0.19 to 0.26; p = .76) and the quality of evidence was judged to be very low. DISCUSSION AND IMPLICATIONS: Lifestyle or behavior change interventions showed limited effect on participation in later life. However, there remains much uncertainty in the estimate of this effect due, in part, to the low quality of the included studies. Measurement tools that are responsive to changes in participation in older adulthood should be used to determine the effect of such interventions. Improving study design will lead to more efficacious interventions that promote participation for our aging population.