Deciphering the role of physical activity in stress management during a global pandemic in older adult populations: a systematic review protocol

The world as we know it has changed dramatically since the beginning of 2020, largely impacted by the pandemic caused by the SARS-COV-2 virus, also known as COVID-19. It has had a devastating effect on global economies and health care outcomes (i.e., sickness and loss of life), particularly for the older adult population worldwide [1]. According to the World Health Organization, older adults have an increased risk of developing serious symptoms from the illness [2]. At the onset of the pandemic, multiple stay at home orders were instituted. This prevented meaningful social connections and reduced possibilities of community-based physical activity. With regard to older adult leisure-time activities, increases in television viewing time have been shown to have both negative psychological and physiological manifestations [3]. Before the pandemic, adults aged 65 and older were the highest consumers of cable news [4], and this has been further aggravated by the pandemic. Due to the uncertainty around the pandemic and the increase in time spent indoors, the potential for TV watching and stress is heightened. Due to these  factors and the increased COVID-mortality as it relates to age [1], stress management in the senior population is of utmost importance.

When this pandemic began, older adults were subjected to a novel stress-invoking situation. Guided by Lazarus and Folkman’s transactional theory of stress and coping [5], stress is defined as an imbalance between demands and an individual’s available resources. Stress can occur when the pressure of an event or situation, such as the pandemic, surpasses a person’s capabilities to cope. Researchers have found that stress has a significant negative impact on cognitive abilities in later life [6]. A more dire result of unaddressed stress is suicide. During the SARS epidemic of 2003, there was a substantial spike (32% increase year over year) in suicides for the subgroup of adults aged 65+ in Hong Kong [7]. In an important study looking at the suicide motives of older adults during this time, social disengagement, mental stress, anxiety, and the feeling of being a burden to their families were cited as reasons for the suicides [8]. More importantly for the current pandemic, they recommended that mental and psychological wellbeing be taken into careful consideration when developing epidemic control measures, especially that of older adults. To offset the negative impacts of stress, protective factors need to be explored.One possible cost-effective, non-invasive intervention available to older adults to cope with these circumstances is physical activity. Studies have pointed to physically active people having reduced mental health problems, specifically depressive and anxiety disorders [9]. This evidence points to the wide ranging benefits of physical activity which will benefit many aspects of older adults’ lives. Exercise has been shown to have a protective influence on mental health, specifically in alleviating stress, through the development of resilience. Studies have shown the varying degrees of physical activity intensity in determining negative mood change [10, 11]. This is a key factor for consideration when comparing possible intervention strategies for older adults in that the largest increase in positive effects were seen in the comparison of sedentary individuals and light physical activity (2–4 h per week). Intense activity is not required; gradually increasing baseline activity can be beneficial [10, 11]. This paper will review literature on exercise interventions to explore the optimal type, intensity, and duration of the programs. The level of feasibility of the interventions will also be examined. This review will help inform policy recommendations to support the mental health of older adults as they cope through a pandemic.

This systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; Protocol ID: CRD42020192546). Any protocol amendments will be tracked. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist (PRISMA-P) was used to develop this protocol [12] (see Additional file 1).

To our knowledge, this will be the first review that synthesizes information on the effectiveness of physical activity interventions promoting stress management in older adults aged 50 years and older. Change in stress levels was chosen to address the current pandemic’s strain on older adults and their mental health. We hope to find evidence of the most effective form of physical activity considering variability in the type, duration, and intensity of interventions. This will provide recommendations to guide health practitioners and older adults in choosing the most efficient and effective stress management techniques. The results from the information contained in this review will be distributed via peer-reviewed, open access publication. The review authors will present findings to health care providers and community stakeholders.