Stress, healthy ageing and physical exercise : how physical activity relates to Cortisol, Dehydroepiandrosterone (Sulphate) (DHEA(s)), sleep, physical function and well-being in older adults

Abstract

This PhD thesis investigates the role of physical activity (PA) in enhancing the health and well-being of older adults in care homes. Focusing on the impact of PA on key health indicators such as cortisol and dehydroepiandrosterone (sulphate) (DHEA(S)) levels, sleep quality, and well-being, this research explored the potential of digital interventions in promoting healthy ageing. First, this research uncovered that regular PA improves cortisol and DHEA(S) levels and enhances sleep quality in adults through two systematic reviews and meta-analyses. The findings highlight the need for further research into the mechanisms underlying these effects and the interplay between cortisol, sleep, and PA, particularly in older adults. Second, a realist evaluation of a feasibility study (Intervention One) demonstrated that implementing a digital music and movement intervention in a care home setting is feasible, albeit with challenges such as participant engagement and resource allocation. Notably, the intervention led to improvements in anxiety, depression, and sleep satisfaction among participants. Third, the subsequent pilot RCT (Intervention Two) provided insights into the intervention's efficacy, revealing its positive impact on anxiety, loneliness, fear of falling and DHEA levels despite methodological challenges. It further provided specific progression criteria to proceed to a more extensive randomised controlled trial (RCT). Overall, this thesis represents a progression from a comprehensive systematic literature review to a feasibility study and a pilot RCT, setting a foundation for a future full-scale RCT of a digital music and movement intervention in care homes. It contributes to the understanding of PA's role in promoting healthy ageing, particularly in care home settings. The findings underscore the potential benefits of PA facilitated through digital interventions for older adults’ health and highlight the necessity for further research to optimise intervention implementation strategies, including recruiting a broader spectrum of older adults, especially regarding sex, ethnicity and cognitive capabilities. This is needed to fully comprehend PA's impact on physical and mental well-being among older adults in care home settings.