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Effect of physical exercise on stroke prevalence in the elderly population (above 60 years) in the UK - A quantitative systematic review
According to Reinholdsson (2023), the effect of physical exercise on the prevalence of stroke among the elderly population aged 60 years and above is significantly important in the United Kingdom. Within the rapidly ageing demographic in the United Kingdom, understanding and addressing the health challenges faced by the elderly population is important. As per a report published by Paiva Prudente et al. (2023), stroke is considered to be the leading causeway of morbidity and mortality within this age group.
That is why it is the focus of extensive research within the nation. According to Bai et al. (2022), physical activity is considered to be one of the most widely recognised lifestyle modifications for its positive effect on cardiovascular health, which includes the improvement of blood pressure in association with cholesterol level and overall vascular function. However, the specific association between regular physical exercise and strong incidence in elderly patients remains an area of interest for researchers globally.
The National Health Service within the UK has a commitment towards public health, which provides a unique area of interest for studying this. According to Chui et al. (2023), this is because physical exercise plays a vital role in influencing the prevalence of stroke among the elderly population. This particular demographic population experience an increased rate of stroke due to age-related psychological changes and other health factors.
According to Yang and Wang (2021), engaging in regular physical activity can emerge as a potential protective measure for this demographic population. Several studies have consistently identified positive correlation between exercise and a reduced incident rate of stroke in the elderly population (Steen Krawcyk et al. 2019). There are several psychological benefits of physical activity which contribute to maintaining cardiovascular health while reducing blood pressure and improving cholesterol levels among the population.
According to Men et al. (2022), these benefits are important to prevent ischemic stroke, which is reported to be the major reason for mortality and morbidity rates within this age group. That is why the UK government has recognised the importance of promoting physical activity among the elderly population.
According to the report published by Krawczyk et al. (2019), regular exercise addresses obesity and diabetes commonly contributes towards an increased rate of stroke and acts as a risk factor for other cardiovascular diseases as well. The goal of the study is to identify the effect of physical exercise on the prevalence of stroke in the elderly population in the UK.
According to a report published by Statista (2021), stroke, which is also known as cerebrovascular disease, was the leading cause of 53 deaths per one million population in the UK in 2019. In 2020-21, Approximately 57,000 male population and 52,000 women population in England had an inpatient hospital episode that resulted from a diagnosis of a stroke (Stewart 2022a).
According to the report of Stewart (2022c) published by Statista, Scotland has experienced approximately 6000 men and 5.5000 women being admitted to the hospital with incidents of stroke within that timeframe (Stewart 2022b). Therefore, as per the report, there were approximately 130 thousand hospital admissions of the population in the UK that were due to stroke in the year 2020-21 (Statista 2021).
The annual admission rate due to stroke has slightly increased in the UK from the previously reported cases. According to a recent report published in Statista written by Stewart (2022b), 43% of the total deaths from strokes were attributed to high blood pressure, also called hypertension, in the UK. Furthermore, approximately 29% of the total deaths were attributed to diabetes, whereas 19.4% of the stroke deaths were reported to be due to bad diets among the population (Stewart 2022d).
Figure 1: Mortality rate due to stroke in the UK
(Source: Stewart 2022d)
According to the reports published by Statista by Stewart (2022d), the number of deaths from stroke in England and Wales within the year 2021 was reported to be 7.1 thousand. Among this, 4.7 thousand consisted of the women population aged 85 years and over who died due to stroke as compared to 2.4 thousand men within the same age group who died due to the same reason of disease (Stewart 2022d).
Therefore, it can be said that the mortality rate among the female population due to stroke is much higher than that of the male population in the UK. Approximately similar statistical information is provided in the below image, which describes the number of deaths from stroke in England and Wales in the year 2021 by gender and age.
Figure 2: Gender-based mortality rate due to stroke
(Source: Stewart 2022b)
It is reported that an unhealthy lifestyle is directly associated with the prevalence of stroke among older adults globally. Lack of physical exercise has been reported for abnormal parameters within the population, which includes high levels of cholesterol and increased blood pressure that could lead to the occurrence of stroke among the population (Stewart, 2023). Therefore, it can be said that the association of physical exercise and regular workouts might help to maintain the parameters that act as the risk factors for the prevalence of stroke among the population.
Therefore, from the above information, it can be stated that physical exercise is the chosen public intervention for managing stroke prevalence among the elderly population in the UK. Physical exercise is recognised as an important intervention for cardiovascular health due to its potential effect on stroke risk factors that align with the imperative burgeoning health challenges created by the ageing demographic (Ahlund 2020).
Engagement with physical exercise is associated with several psychological benefits, which include the maintenance of healthy blood pressure in association with improved cholesterol levels and enhanced vascular function. According to Addini et al. (2023), physical exercise plays a vital role in addressing modifiable lifestyle factors which contribute to stroke and increased risk factors.
These factors are especially pertinent for stroke prevention because hypertension and atherosclerosis are the leading cause of cerebrovascular incidents among the elderly population. According to Chu et al. (2022), sedentary behaviour and lack of physical exercise are considered to be major risk factors that lead to several conditions like obesity and type 2 diabetes.
These two conditions act as a comorbidity of cardiovascular diseases, which increase the likelihood of strokes among the elderly population. By engaging regularly with physical exercises, public health interventions can actively target these risk factors and offer a more sophisticated approach to preventing stroke in the elderly population.
According to Taylor et al. (2021), the socio-economic implication identifies the significance of physical activity as one of the preventive strategies for stroke. Economic benefits can be manifested with the help of reduced healthcare costs in association with stroke treatment rehabilitation and long-term care needs.
Stroke incidents represent a substantial economic burden on the health care system, and societal interventions that empower the elderly population to adopt and maintain active lifestyles can help alleviate this stress on society. According to Randriambelonoro et al. (2020), within the context of the National Health Service in the UK, campaigning about physical activity as a public health intervention would align with the principle of preventive health care and health promotion.
This is because this campaign would not only help address the immediate health concerns of the elderly population but would also align with the broader goal of enhancing the overall well-being of the ageing population.
According to Manser et al. (2023), implementation and promotion of physical exercise programs that are developed for the elderly population would help to provide public health awareness among the population with the help of these campaigns for contributing to a shift in stroke-preventing strategies in the population.
With a proper understanding of the transformative capability of physical activity, public health intervention possesses the capacity to significantly reduce the incidence rate of stroke while improving the quality of life of the elderly population and creating economic dividends for the healthcare system and society.
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The major for conducting this research work is due to the urgent requirement to address the escalating health challenges created by stroke incidents among the ageing demographic in the UK. The UK has been experiencing a rapid age within the population with an increase in the proportion of individuals aged 60 and above.
Therefore, increasing awareness to improve understanding and mitigate the risk factors which are associated with stroke is important to maintain a balance because stroke is considered to be the leading causeway of morbidity and mortality in the elderly population (Hamer et al. 2021).
The incidence of stroke places a significant burden on the healthcare system and the broader economy of the nation, which triggers the importance of addressing the risk factors associated with it in the general population. Stroke represents a substantial public concern in the UK, which is increasing with time.
According to Solis-Navarro et al. (2022), stroke incidents are also a leading cause of disability among the elderly population, which triggers the requirement for identifying effective preventive measures for enhancing the overall health and well-being of the elderly population.
According to Wu et al. (2022), the economic implication of stroke also highlights the significance of this research because the financial burden associated with stroke-related healthcare costs, along with rehabilitation surveys and long-term care, is increasing with time.
Therefore, by focusing on physical exercise as the potential intervention, this research aims to provide valuable information about the modifiable lifestyle factor which could play a vital role in reducing the incidence of strokes among the elderly population.
The aim of this research is to perform a quantitative systematic review that would help to analyse the effect of physical exercise on stroke prevalence in the elderly population with an age above 60 years.
The objectives of this quantitative systematic review are as follows:
a) To understand the prevalence of stroke in the elderly population
b) To analyse the effect of physical activity on the different age groups of the elderly population ranging from 60 to 80 years
c) To understand the role of physical exercise on stroke prevalence in the elderly population
d) To analyse the effectiveness of physical exercise on stroke prevalence in the elderly population
The PIO Framework will be used to develop the research question that would help to address the objectives of this current study. The factors that will be considered in this framework include Population, Intervention and Outcome.
| Population | Intervention | Outcome |
| Elderly population who experienced stroke once | Physical activities to control diabetes | Stroke management and control in elderly population. |
Table 1: Research question table (PIO)
Based on the above table, the research question that will be developed is as follows: “What is the effect of physical activity on stroke prevention among the elderly population in the UK?”
This section will discuss the research methodology that will be used to conduct this research work with a mention of a specific design, research plan, and research strategy that will be suitable for this current proposed study to address the research question.
This section will further discuss the source strategy study selection criteria and procedures, Followed by exposure type and outcome types. The final part of this section describes the approach that will be used for the quality assessment of the collected evidence for this current systematic review research study.
A comprehensive search strategy will be used to conduct a systematic literature review on the effect of physical exercise on stroke prevalence in the elderly population above 60 years in the UK. This search strategy includes keyword strategies that are directly derived from the research topic, which will be used with synonyms to increase search inclusivity. Another source strategy, namely BOOLEAN Operators with a special preference for AND and OR, will be used to understand the relationship between keywords and their synonyms (Al-Ababneh 2020).
The databases that will be used for retrieving relevant articles and peer-reviewed journals include PubMed, MedLine, CINAHL, and Cochrane. These databases will be used for comprehensive coverage of the relevant research studies. The table below consists of the search strategy, which aims to optimise the retrieval of relevant literature which aligns with the methodology that has been established for this current systematic review.
| Search terms/Framework | Keywords | Synonyms | BOOLEAN operators |
| P (Population) | Elderly patient | Older people, older individuals, Above 60 years, Above 70 years, Above 80 years, Older population, Elderly Population, Elder people, Older population | OR |
| I (Interventions) | Physical activity interventions | Physical exercise, physical activity | OR |
| O (outcomes) | Diabetes control | Control of stroke, Stroke management, Management of stroke, Prevalence of stroke | OR |
| N/A | AND | AND | BOOLEAN operators |
Table 2: Search strategy using keywords and BOOLEAN operators
The use of a keyword table has been observed to be highly effective for quantitative systematic literature review, as it helps guide the research process and identify relevant evidence for the review purpose (Belur et al. 2021). Similarly, using this type of table for the representation of keyword search strategy for the current proposed quantitative systematic literature review is justified and a perfect strategic choice to represent the data systematically.
Will involve elderly patients above 60 years from both healthcare facilities and the community. The principal investigator is the physical activity, which will be associated with both the environment. This present study will address the health issue of stroke among elderly patients.
Other terminologies associated with cardiovascular diseases will not be used in the research process, which would help to ensure a comprehensive search of literature that is related to only stroke in the elderly population across different settings and age groups.
This set is on physical activity as the intervention, which encompasses different types of exercises. The type of physical activity that will be applied for different age groups depends on their capability and physical strength. The intensity of physical activity depends on the type of exercise performed by different age groups as it differs from one demographic group to another.
The differentiation is done based on the capability of the age group, as the physical exercise that can be performed by an individual of 60 years cannot be done by an individual of 80 years. It is also differentiated based on the physiological status of the individuals. This would help to offer a comprehensive analysis of the different physical activities under investigation.
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Using the data collection process with the help of keyword source strategy for the current systematic literature review. The primary health outcome will include reduced blood pressure level and reduced blood cholesterol level.
The secondary outcome would include analysing the quality of life among the elderly population during the search process. These specific outcomes form the comprehensive framework for the data collection process in the current systematic literature review with the usage of the keyword-based search strategy.
The reason for choosing a primary research design-based study is justified due to the quantitative systematic literature review for this current study. With the emphasis on the quantitative nature of the systematic literature review, the important criterion for study selection is the inclusion of quantitative research studies (Alharahsheh and Pius 2020).
To ensure a comprehensive analysis, papers published in English within the time frame from 2013 to 2023 will be considered for this current study. This will help to reduce the risk of overlooking relevant data in the systematic literature review. This chosen time frame aligns with the focus of the study and aims to analyse information from recent developments and insights that are relevant to the chosen quantitative research synthesis approach.
| Criteria | Inclusion | Exclusion |
| Population | Elderly patient population with ages above 60, above 70, and above 80 years. | Young people, people with their age less than 60 years, and middle-aged people, |
| Interventions | Physical exercise | Other non-pharmacological and pharmacological interventions |
| Outcome | Stroke management | Control of other cardiovascular disease. |
Table 3 – Inclusion and Exclusion Criteria table
Based on the qualitative research design for the selected studies that will be used in this current systematic literature review, the reason for using critical appraisal skills programme (CASP) quantitative checklists is justified for analysing the quality and procedures of the study.
The CASP quantitative checklist will be used for constructing a comprehensive table and incorporating it into the checklist (Cr 2020). This selection of the quality appraisal tool aligns with the data set by a similar quantitative SLR on a related topic.
This table will serve as the framework that can be used to systematically evaluate the quality of the papers that have been selected for the proposed research study (Hasan 2021). This approach will help to ensure a rigorous and standardised approach for systematically assessing the process.
Extraction of data for systematic literature review is done with the use of a data extraction table (Herzog et al. 2019). Therefore, for this present systematic literature review, a similar data structure table will be used, as shown in the below table format.
| Author Names | Aim | Participants | Design | Exposure | Primary outcome measures | Key findings |
| Raimundo et al. (2021) | To compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute about of aerobic exercise | Elderly patients | Quantitative | Physical exercise | Cardiac autonomic modulation | Reduced variability at rest, no return to baseline after 30 mins of recovery, Sympathetic predominance during exercise |
| Gorna & Domaszewska (2022) | To determine whether a single boat of endurance activity or long-term endurance activity regulates exercise dependence serum brain-derived neurotropic factor level (BDNF) | Elderly patients | Quantitative | Physical exercise | Exercise-dependent Serum Brain-derived neurotrophic factor (BDNF) level | Endurance exercise may augment the peripheral BDNF Concentration among post-stroke individuals |
Table 4 – Data extraction table that will be used with some studies matching the criteria
The finding section presented above with the data extraction table will be analysed to gather relevant information to answer the research question by systematically synthesising the findings.
This data extraction approach is used in almost every systematic literature review paper, which justifies the selection of this approach for the present study (Linares-Espinós et al., 2018). The final table of the systematic literature review will contain more research papers in a descending manner based on their data generalisation.
The quantitative systematic literature review proposed for this current study will use narrative analysis to identify common trains from the collected evidence. The native analysis in the quantitative research study involves a systematic examination of the narratives for identifying the patterns of the data collected from the research papers (Mazhar et al. 2021). The researcher will focus on interpreting the core narratives from the study group by organising the relevant data to understand how physical exercise affects stroke prevention among elderly patients.
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