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

Abstract

Objective

To evaluate the effects of therapeutic exercise and psychological interventions on disability and personal outcomes in older adults.

Data Sources

Articles published from January 2013 to February 2025 are available in PubMed, Embase, ProQuest Health & Medical and Psychology, PsycINFO, and PsycArticles.

Study Selection

Inclusion criteria were as follows: (1) intervention included therapeutic exercise combined or integrated with a psychological intervention; (2) randomized controlled trial; (3) sample mean age ≥60 years; (4) primary or secondary outcome(s) of disability. Two authors independently screened trials (n=7391) for inclusion; a third author verified results and resolved discrepancies.

Data Extraction

Data were extracted by a primary reviewer and verified by a second reviewer. The risk of bias assessment was performed using the risk of bias in randomized controlled trials.

Data Synthesis

Thirty-eight trials (n=18,550 participants) were included. Therapeutic exercise included: exercise programs (34%), physical activity counseling and monitoring (37%), rehabilitation (18%), or other (eg, Tai Chi; 13%). Psychological interventions were primarily motivational interviewing (53%) or cognitive-behavioral therapy/strategies (39%). Significant improvement in body functions and structures (n=14, 37%), activity (n=6, 16%), participation (n=20, 53%), and personal factors (n=11, 29%) was observed.

Conclusions

Therapeutic exercise with psychological interventions have a positive effect on disability and personal outcomes, especially in participation. Heterogeneity in the study design, intervention, and population challenged data synthesis. Nonetheless, the current review identified gaps within the literature and directions for future research. Testing the additive effect of these interventions compared to active comparators is a priority for future investigations.