Physical Activity Interventions for Rural Older Adults Through a Social Ecological Model Lens: A Systematic Review.

BACKGROUND: Rural older adults face unique barriers to physical activity (PA), including geographic isolation, limited resources, and social constraints. Despite the well-documented benefits of PA, rural older adults are less likely to meet PA guidelines than their urban counterparts. This systematic review evaluates the effectiveness, implementation, and sustainability of PA interventions for rural older adults through the lens of the social ecological model. METHODS: A comprehensive literature search was conducted in PsycINFO, PubMed, and Web of Science, identifying 1,023 articles. Eleven studies met inclusion criteria, focusing on PA interventions for adults aged 60 and older in rural settings. Data on intervention type, sample characteristics, and rurality measures were extracted. Interventions were categorized using social ecological model levels: individual, interpersonal, organizational, and community. RESULTS: Individual-level interventions (n = 3, 27%) improved physical function, with adherence rates up to 90%. Interpersonal interventions (n = 4, 36%) enhanced exercise self-efficacy and daily step counts. Organizational interventions (n = 2, 18%) demonstrated success in fall prevention and retention. Community-level interventions (n = 2, 18%) leveraged local resources to address geographic and social barriers. CONCLUSION: Findings suggest that PA interventions engaging multiple levels of the social ecological model show the most promise for rural older adults, though standardizing rurality definitions and measurement approaches across studies will be critical for advancing this field of research. IMPLICATIONS: These findings highlight the need for multilevel, contextually tailored interventions to enhance PA participation among rural older adults. Future research should explore scalable strategies that address rural-specific barriers and improve long-term sustainability.