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Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

Booth, Vicky; Harwood, Rowan H.; Hancox, Jennie E.; Hood-Moore, Victoria; Masud, Tahir; Logan, Phillipa

Authors

Victoria Hood-Moore

Tahir Masud

PIP LOGAN pip.logan@nottingham.ac.uk
Professor of Rehabilitation Research



Abstract

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. Objectives This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation. Design A realist review of the literature. Data sources EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO. Eligibility criteria Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community. Data extraction and synthesis A â €" rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study. Results An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a â €" gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-To-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered. Conclusion Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia. PROSPERO registration number CRD42015030169.

Citation

Booth, V., Harwood, R. H., Hancox, J. E., Hood-Moore, V., Masud, T., & Logan, P. (2019). Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review. BMJ Open, 9(6), https://doi.org/10.1136/bmjopen-2018-024982

Journal Article Type Article
Acceptance Date May 21, 2019
Online Publication Date Jun 19, 2019
Publication Date Jun 19, 2019
Deposit Date May 28, 2019
Publicly Available Date Mar 29, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 9
Issue 6
Article Number e024982
DOI https://doi.org/10.1136/bmjopen-2018-024982
Keywords Dementia; Cognitive impairments; Exercise; Accidental falls
Public URL https://nottingham-repository.worktribe.com/output/2097242
Publisher URL https://bmjopen.bmj.com/content/9/6/e024982

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