Apathy and Physical Activity: A Systematic Review and Meta-Analysis

Background Patient motivation is essential for the success of their rehabilitation. Apathy, a state of primary motivational deficiency, may therefore hinder physiotherapists’ interventions, such as those aimed at increasing patients’ physical activity. This study aims to examine the negative relationship between apathy and physical activity and to identify the factors that influence this relationship. Objective This study aims to explore the negative association between apathy and physical activity, identifying factors influencing this relationship. Methods Six databases were searched for articles including both a measure of apathy and physical activity. Two reviewers screened articles for inclusion, assessed risk of bias, and extracted data from each study. Pearson product-moment correlations were pooled from eligible studies using the generic inverse pooling and random effects method to examine the relationship between apathy and physical activity. Results Twenty-eight articles were included in the systematic review and 22 studies (n = 12,541 participants) in the meta-analysis. Results showed a small negative correlation between apathy and physical activity (r = -0.13; 95% CI: -0.18 to -0.09; p < 0.0001). A subgroup meta-analysis revealed that the correlation was statistically significant in patients with Parkinson’s disease and in older adults who were healthy, depressed, fallers, or had mild cognitive impairment. A meta-regression suggested an effect of age, with older age being associated with a stronger correlation between apathy and physical activity. Conclusions Our results suggest that higher levels of apathy are associated with lower levels of physical activity and that this negative association is strengthened with aging. Therefore, apathy could be a limiting factor to exercise therapy and may have prognostic implications in patients whose condition requires physical activity. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Matthieu P. Boisgontier is supported by Natural Sciences and Engineering Research Council of Canada (NSERC; RGPIN-2021-03153), the Canada Foundation for Innovation (CFI 43661), and Mitacs. Ata Farajzadeh is supported by an Admission Scholarship, a Doctoral International Scholarship, and a Special Merit Scholarship from the University of Ottawa. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at