Associations between meeting 24-hour movement guidelines and health-related quality of life in older adults: a systematic review and meta-analysis.

backgroundAdherence to 24-h movement guidelines that include physical activity (PA), sedentary behaviour (SB), and sleep is linked to improved health outcomes, yet its impact on health-related quality of life (HRQoL) in older adults remains underexplored.

objectiveThis study investigated the relationship between adherence to guidelines for 24-h movement behaviours and HRQoL in older adults.

methodsA systematic search of four databases was conducted to identify studies published from the date of inception to January 2025. The Appraisal Tool for Cross-Sectional Studies was used to assess the risk of bias among the included studies. Random-effects models were used to conduct a meta-analysis involving the extracted proportions and odds ratios (OR) from each study. The Freeman–Tukey transformation was applied to stabilise the variance of proportional data before meta-analysis, and pooled proportions were back-transformed to their original scale for reporting. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated using Begg’s test. A sensitivity analysis was conducted, which included changing the random-effects model to a fixed-effects model and adopting a leave-one-out analysis.

resultsTwenty-five cross-sectional articles were included, covering a total of 170,670 older adults aged ≥ 60 years. We found that 24.3% (95% confidence interval [CI]: 22.1%–26.5%, p < 0.01) of older adults adhered to at least one movement guideline, among whom 23.0% (95% CI: 20.8%–25.2%, p < 0.01, n = 18) adhered to PA guidelines, 18.5% (95% CI: 15.3%–21.7%, p < 0.01, n = 7) to SB guidelines, and 40.0% (95% CI: 37.5%–42.5%, p < 0.01, n = 7) to sleep guidelines. Our meta-analysis suggests that compared with non-compliance, adherence to at least one 24-h movement guideline was associated with higher HRQoL among older adults (OR = 1.65, 95% CI: 1.44–1.89, p < 0.01, I^2 = 95.5%, n = 15). Small-study effects were examined with Begg’s test; all subgroup analyses of individual guidelines were underpowered due to a small number of included studies (n < 10: PA n = 7, SB n = 5 and SL n = 4).

conclusionAdherence to at least one 24-h movement guideline is associated with better HRQoL in older adults. However, the lack of available research—primarily due to an insufficient number of studies reporting data on multi-component adherence—limits our ability to conduct further analyses on the association between adherence to a combination of two to three movement guidelines and HRQoL.