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

BACKGROUND: Adherence 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. OBJECTIVE: This study investigated the relationship between adherence to guidelines for 24-h movement behaviours and HRQoL in older adults. METHODS: A 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. RESULTS: Twenty-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). CONCLUSION: Adherence 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.