Barriers to and facilitators of physical activity among community-dwelling older adults: a systematic review

Key points

1. 01Fear of falling or injury was one of the most widely cited personal barriers across included studies
2. 02Over 95% of participants in one study reported pain as a limiting factor, and 45-82% reported not having enough time
3. 03Social support, exercising with a partner, friend, group or pet was a consistent facilitator across qualitative and quantitative studies
4. 04Poor weather was the single most reported environmental barrier, cited by up to 97% of participants in one Australian study and 89% in one Finnish study
5. 05Age-friendly built environments, subsidised programmes, and reassurance from health professionals were key environmental and interpersonal facilitators

How it was conducted

Design

Systematic review with narrative synthesis using the socioecological model

Databases searched

MEDLINE, Embase, APA PsycINFO, SPORTDiscus, CINAHL Plus, AgeLine, Scopus (inception to 14 April 2024)

Included study types

11 qualitative, 1 mixed-method, 8 quantitative (cross-sectional and one 5-year prospective cohort)

Participants

18,597 total; community-dwelling adults aged 65 years and older without functional disability or palliative care needs

Primary outcome

Barriers to and facilitators of physical activity, categorised as intrapersonal, interpersonal and environmental factors

Quality appraisal

CASP for qualitative studies, JBI checklist for quantitative, MMAT for mixed-methods; inter-rater reliability 82%

What they found

• 20 studies were included from 27,779 screened articles, with a total of 18,597 participants
• One Australian quantitative study found 97% of participants cited poor weather as a deterrent to physical activity
• One Finnish study found 89% of participants reported darkness as a significant obstacle to physical activity engagement
• One study found over 95% of participants reported pain as a limiting factor for physical activity
• Time constraints were reported by 45-82% of older adults across multiple quantitative studies
• In one Finnish study, more than half of participants in each of three studies attributed lack of physical activity to poor health
• 4 out of 11 qualitative studies received full CASP scores; 4 out of 8 quantitative studies received full JBI scores

Limitations

• Most included studies were conducted in high-income countries with predominantly Caucasian participants, limiting generalisability to low- and middle-income settings and other ethnic backgrounds
• Inclusion was restricted to English-language publications, potentially excluding relevant evidence in other languages
• Findings may not reflect experiences of older adults in care facilities or those with functional disabilities or life-limiting conditions
• All quantitative studies were cross-sectional, limiting causal inference about barriers and facilitators

Why it matters

For patients

Older adults can recognise that fear, pain, cost and lack of social support are common and addressable obstacles, and that finding enjoyable, low-cost, socially connected activities is one of the most effective ways to stay active.

For clinicians

Clinicians should address both personal barriers (fear of injury, pain) and environmental ones when promoting physical activity, and consider referring patients to subsidised community programmes or using reassurance and fitness technology to support engagement.

For readers

This review maps the full range of factors that shape physical activity in healthy older adults and provides a framework for designing multilevel policy and programme interventions targeting individual, social and built-environment factors simultaneously.