Background
Aims
Study design and methods
Eligibility criteria
Participants/study population
Intervention
Comparison
Outcomes
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Self-reported function/disability: measures aiming to quantify either the degree of functioning or disability in an individual in his/her life setting. These measures should be obtained from questionnaires, either self-administered or by interview, or by proxy (observation) as this approach is common in studies of the oldest old and institutionalized.
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Functional capacity/limitation: objective measures of activities such as gait, stair climb, chair-rise and various imitated ADLs and IADLs, like transferring, personal care, and household obtained under standardized circumstances.
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Muscle function/impairment: measures of strength, power and muscle mass.
Trial design
Information sources and searches
Study selection
Data collection and extraction
Extraction of primary and secondary outcome data
Descriptive data
First author, year, country | Ades et al., 2003, USA [32] | Benavent-Caballer et al., 2014, Spain [33] | Binder et al., 2002, USA [15] | Boshuizen et al., 2005, the Netherlands [34] |
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Setting | Cardiac rehabilitation facility | Geriatric nursing home | University indoor exercise facility | Two senior welfare centres |
Design | RCT, parallel | RCT, parallel, four-armed | RCT, parallel | RCT, parallel, three-armed |
Aims of the study | To evaluate the value of resistance training on measures of physical performance in older women with coronary heart disease | To evaluate the short-term effects of three different low-intensity exercise interventions on physical performance, muscle CSA and ADL. | To evaluate whether a multidimensional exercise training program can significantly reduce frailty in community-dwelling older men and women | To investigate if there are differences in the effects of an exercise intervention due to the applied intensity of supervision |
Sample size (analyzed), n | IG: 19, CG: 14 | IG: 22, CG: 23 | IG: 66, CG: 49 | IGc: 32, CG: 17 |
Female gender, n | Overall: 100% | IG: 68.1%, CG: 65.2% | IG: 52%, CG: 53% | IGc: 30/32 (92%), CG: 15/17 (88%) |
Mean age (SD), years, range | IG: 73.2 (6.0), CG: 72.2 (5.7) | IG: 85.5 (4.7), 83.6 (5.6), 75–96 | IG: 83 (4), CG: 83 (4) | IG1: 80,0 (6,7), IG2: 80,8 (5,3), CG: 77,2 (6,5) (completers only) |
Participant health status (functional limitation criteria) | Patients had CHD diagnosed for > 6 months, MOS SF > 36, physical function domain score < 85 | Residents in geriatric nursing home | Defined frailty criteria including: Objective test, reported ADL and IADL dependency | Difficulty in rising from a chair and unilateral knee extensor strength below 25 kgf. |
Residential status | Community-dwelling | Geriatric nursing home | Community-dwelling | Apartments for elderly connected to welfare centres |
Description, intensity, duration and total number of sessions | 8 RT exercises focusing on leg, arm, and shoulder. Progressive program updated monthly | Low intensity RT program targeted major knee extensor muscles. 40% 1RM, 16 weeks, 48 session | Progressive whole-body RT program in weightlifting machines. 65–100% 1RM, 12 weeks, 36 sessions | 9 thigh muscles exercises. Resistance provided by body weight and elastic bands. 4–8 RM (elastic band exercises) 10 weeks, 30 sessions |
Control condition | Control patients met 3 times per week performing stretching, calisthenics, deep-breathing progressive-relaxation exercises, and light yoga | No intervention. Refrain from participation in exercise programs | Sham intervention: 9 flexibility exercises | No intervention. Maintain habitually active |
Self-reported measure of ADL-disability/function | MOS SF-36, physical function domain | Barthel Index | Functional Status Questionnaire | The Groningen Activity Restriction Scale (ADL/IADL) |
Drop-out from intervention, n | IG: 5 (21%), CG: 4 (22%) | IG: 4 (18%), CG: 4 (17%) | IG: 20 (30%), CG: 8 (16%) | IGc: 18 (36%), CG: 5 (23%) |
Compliance, % (criteria) | Patients were required to attend at least 54/72 sessions (75%). 2 patients failed, and were recorded as dropouts | 78% (mean attendance at sessions) | 100% (attendance at sessions. Less than 100% attendance led to exclusion) | IG1: 79%, range: 57–100%, IG2: 72% range 20–93% (mean attendance at sessions) |
Direction of the effect on self-reported disability/function | No effect | Positive effect | Positive effect | No effect |
Adverse events | No adverse events | No adverse events | One: rotator cuff injury, and one: RT exacerbating shoulder problem | Not reported |
Notes | RT is the second of three 3-months intervention phases. We consider 3- and 6-month time points as baseline and endpoint test respectively | Two eligible RT-intervention groups. Degree of supervision varied between groups | ||
Data notes | Published and unpublished data | Data from the two intervention groups were collapsed in all analysis | ||
Included in primary meta-analysis | Yes | Yes | Yes | Yes |
First author, year, country | Buchner et al., 1997, USA [35] | Cadore et al., 2014, Spain [36] | Chandler et al., 1998, USA [16] | Chin A Paw, et al., 2006, the Netherlands [37] |
Setting | Enrolees in a health maintenance organization | – | The home of the elderly | Long-term care facilities |
Design | RCT, parallel, four-armed | RCT, parallel | RCT, parallel | RCT, parallel, four-armed |
Aims of the study | To investigate the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health service’s use in older adults | To investigate the effects of multicomponent exc. Intervention on muscle power output, muscle mass, tissue attenuation, fall risk and functional outcomes | To determine whether strength gain is associated with improvement in physical performance and disability | To evaluate the effectiveness of three different training protocols on functional performance and self-rated disabilities of older adults living in long-term care facilities. |
Sample size (analyzed), n | IG: 22, CG: 29 | IG: 11, CG: 13 | IG: 44, CG: 43 | IG: 40, CG: 31 |
Female gender, n | IG: 52%, CG:50% | 17/24 (70%) (completers only) | Overall: 50% | IG:29/40 (73%), CG26/31 (84%) |
Mean age (SD), years, range | IG: 74, CG: 75 No SD | IG: 93,4 (3,2), CG: 90,1 (1,1) | IG: 77,5 (7,1), CG 77,7 (7,8) | IG: 80,9 (5,7), CG: 81,2 (4,4) |
Participant health status (functional limitation criteria) | Unable to do an 8-step tandem gait without errors, below the reference 50th percentile in KE strength | Frieds frailty criteria, institutionalized | Inability to descent stairs step by step without holding the railing | Living in long-term care facilities. The population is referred to by the authors as frail |
Residential status | Community-dwelling | Institutionalized | Community-dwelling | Nursing home/residential care |
Description, intensity, duration and total number of sessions | RT of the upper and lower body using Cybex Eagle weight machines. Including training at the ankle joint using adjustable weights | 3 RT-exercises. 2 for knee extensors + chest press in machines (20 min). Gait and balance exercises (10 min). 8–10 RM, 12 weeks, 24 sessions | Home-based low-moderate intensity RT-programme using elastic band. Exercises target lower extremity muscles with slow velocities of movement. 10 RM, 10 weeks, 30 sessions | Long term care facility-based. 5 RT-exercises using machines, free weights and ankle/wrist weights. 60–80% 1RM, 24 weeks, 48 sessions |
Control condition | Instructed to maintain usual activity | No intervention. Routine care and activities | No intervention. Controls were offered RT after the end of the trial | Attention control. Educational program led by professional creative therapist. 45–60 min twice weekly. |
Self-reported measure of ADL-disability/function | Sickness Impact Profile, body care and movement subscale | Barthel Index | MOS SF-36, physical function domain | Disability in 17 ADLs |
Drop-out from intervention, n | IG: 5 (20%), CG: 1 (3%) | IG: 5 (31%), CG: 3 (19%) | Overall: 13 (13%) | IG: 21 (37%), CG: 23 (45%) |
Compliance, % (criteria) | IG: 95% (mean attendance at sessions) | 90% (attendance at sessions. Attendance was defined as ≥90% of prescribed exercises completed) | Not reported | 76% (mean attendance at sessions) |
Direction of the effect on self-reported disability/function | No effect | Positive effect | No effect | No effect |
Adverse events | No adverse events | Not reported | Not reported | No adverse events reported. N = 8 dropped out because the program was too intensive |
Notes | One intervention group was eligible for inclusion in the analysis | One intervention group was eligible for inclusion in the analysis | ||
Data notes | Ceiling effects of the Sickness Impact Profile, body care and movement-subscale was reported | Published and unpublished data | Post data not available | |
Included in primary meta-analysis | Yes | Yes | No | Yes |
First author, year, country | Clemson et al, 2012, Australia [38] | Danilovich et al., 2016, USA [39] | Fahlman et al., 2007, USA [40] | Hewitt et al., 2018, Australia [41] |
Setting | Residents in metropolitan Sydney, Australia | Home-based, Illinois | University facilities, Urban area | Long -term residential aged care facilities |
Design | RCT, parallel, three-armed | RCT, parallel | RCT, parallel, three-armed | RCT, Cluster |
Aims of the study | To determine if a lifestyle integrated approach to balance and strength training is effective in reduces the rate of falls in high risk people | To test the effect of an RT-program on the physical performance and self-rated health of older adults receiving home and community-based services | To determine whether RT or a combination of RT and aerobic training resulted in the most improvement in measures of functional ability in functionally limited elders | To test the effect of published best practice exercise in long-term aged care, and determine if combined balance and progressive RT is effective in reducing the rate of falls |
Sample size (analyzed), n | IG: 79, CG: 80 | IG: 24, CG: 18 | IG: 39, CG: 33 | IG: 93, CG: 82 |
Female gender, n | IG: 57/105 (54,3%), CG: 58/105 (55,2%) | Overall: 83% | Not reported | IG: 71 (62.8%), CG: 73 (68.2%) |
Mean age (SD), years, range | IG: 84,03 (4,38), CG: 83,47 (3,81) | CG: 74,1, CG: 75,6 | IG: 74,6 (SE;1,0), CG: 76,5 (SE 1,4) | IG: 86, 65–100, CG: 86, 65–99 |
Participant health status (functional limitation criteria) | Two or more falls or one injurious fall in the past 12 months | Homebound, receiving long-term ADL-assistance and home management | Score < 24 on the SF-36 PFD (reference score = 30) | High- or low-care requirements (daily assistance by nurse / some assistance but not complex care-needs) |
Residential status | Community-dwelling | Community-dwelling, homebound | Community-dwelling | Long-term residential care |
Description, intensity, duration and total number of sessions | Structured home-based programme. 7 exercises for balance + 6 exercises for lower limb strength 3 times a week, 1 year | Health care assistant and DVD-delivered, RT program with elastic bands | RT program consisting of 13 exercises using resistive bands. Low-moderate intensity, 16 weeks, 48 sessions | Moderate intensity progressive RT program consisting of 5 exercises combined with high-progressive level balance program. 25 weeks, 50 sessions |
Control condition | Sham intervention: 12 gentle flexibility exercises | No intervention. Usual care | No intervention. They were instructed to maintain their current level of activity | No intervention. Usual care |
Self-reported measure of ADL-disability/function | The National Health and Nutrition Examination Surveys independence measure for Activities of Daily Living (NHANES ADL) | Patient-Reported Outcomes Measurement Information System (PROMIS), physical summary score/ADL | MOS SF-36, physical function domain | MOS SF-36, physical function domain |
Drop-out from intervention, n | IG: 22 (21%), CG: 16 (15%) | IG: 3 (13%) | Not reported | IG: 16 (14%), CG: 15 (14%) |
Compliance, % (criteria) | IC: 35% (SD: 29), CG: 47% (SD: 34) (adherence to programmes) | Not reported | Not reported | 54% (SD: 14.3) attended at least 30 sessions (60% adherence). Median attendance: 35 sessions |
Direction of the effect on self-reported disability/function | No effect | No effect | No effect | No effect |
Adverse events | One Surgery for inguinal hernia due to groin strain | No adverse events | Not reported | No major events. N = 3 reported short-term musculoskeletal pain, n = 1 non-injurious fall |
Notes | RT-program based on Jette 1996 | One intervention group was eligible for inclusion in the analysis | 48.9% of participants had a diagnosis of mild to moderate cognitive impairment | |
Data notes | Pre and post results are presented for different subsamples | Extraordinary small sizes of variability distorted the meta-analysis of SMDs | Pre and post results are presented for different subsamples | |
Included in primary meta-analysis | No | Yes | No | No |
First author, year, country | Latham et al., 2003, New Zealand [42] | McMurdo and Johnstone, 1995, USA [43] | Mihalko and McAuley 1996, USA [44] | Sahin et al., 2018, Turkey [45] |
Setting | Five urban hospitals in New Zealand/Australia | The home of elderly receding in sheltered housing | Nursing home or senior citizen facility | Not reported |
Design | RCT, parallel, four-armed | RCT, parallel, three armed | RCT, parallel | RCT, parallel, three armed |
Aims of the study | To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving physical health of frail older people after hospital discharge | To develop a low technology approach to home exercise provision for elderly people with restricted mobility | To examine the effects of upper body high-intensity strength training on muscular strength levels, ADLs, and subjective well-being in elderly males and females. | To evaluate changes in the functioning of frail older adults after undergoing RT 3 days a week for 8 weeks |
Sample size (analyzed), n | IG: 112, CG: 110 | IG: 21, CG: 28 | IG: 29, CG: 29 | IGc: 32, CG: 16 |
Female gender, n | IG: 55%, CG: 51% | IG: 19/21 (90%), CG: 25/28 (89%) | Overall: 83% | Not reported |
Mean age (SD), years, range | IG: 80 (range: 79–81), CG: 78 (range: 77–80) | IG: 81,4 (3,4), CG:81,9 (4,7) | Overall: 82.67 (7.72) | IG1: 84.18 (6.85), IG2: 84.50 (4.81), CG: 85.37 (4.70) |
Participant health status (functional limitation criteria) | Frail according to criteria (Winograd). Admitted to geriatric rehabilitation unit. | Limited mobility, dependence in ADL | 19 used a wheelchair, 13 used walking assistance | Frailty according to Fried criteria |
Residential status | Not specified | Sheltered housing | Nursing home | Nursing home |
Description, intensity, duration and total number of sessions | Home-based quadriceps resistance program using adjustable ankle cuff weights. 3 sets of 8 reps of knee extensions in a seated position. | Low technology, low cost home exercise program using elastic bands. Emphasis on safety and respect for pain. 6 months with training on daily basis. No data on intensity | Upper body RT program with one exercise for the following muscle-groups: pectorals, latissimus dorsi, deltoids, biceps, and triceps. Performed with dumbbells | 11 RT exercises for upper and lower body. 1 set of 6–10 reps at a slow speed (6–8 s/rep). IG1: 70% 1RM IG2: 40% 1RM. 8 weeks, 24 sessions |
Control condition | Received frequency-matched telephone calls and home visits from physical therapist who inquired about patient’s recovery, gave general advice. | Frequency and duration matched health education program. Informal discussions on exercise, diet, sleep, meditation, stress foot care and safety | Upper body, no-stress exercise program: Breathing techniques; movement of the neck, shoulder, arms, hands, and torso; and mild stretching activities | Instructed to continue usual daily routines |
Self-reported measure of ADL-disability/function | MOS SF-36, physical function domain | Barthel Index | Barthel Index, tailored | Barthel Index |
Drop-out from intervention, n | IG: 8 (7%), CG: 13 (10%) | Overall: 20% | Not reported | IGc: 0, CG: 0 |
Compliance, % (criteria) | 82% (mean attendance at sessions) | Not reported | Not reported | Not reported |
Direction of the effect on self-reported disability/function | No effect | No effect | Positive effect | Positive effect |
Adverse events | The exercise group had an increased risk of musculoskeletal injury and higher scores of fatigue. | No adverse events | Not reported | Not reported |
Notes | One intervention group was eligible for inclusion in the analysis | Two eligible RT-intervention groups. Work load intensity varied between groups. | ||
Data notes | Missing baseline data | ANCOVA test applied to account for baseline imbalances | Data from the two intervention groups were collapsed in all analysis but the sub-analysis for training intensity | |
Included in primary meta-analysis | No | Yes | Yes | Yes |
First author, year, country | Seyennes et al., 2004, France [17] | Timonen et al., 2006, Finland [46] | Venturelli et al., 2010, Italy [47] | Westhoff et al., 2000, the Netherlands [18] |
Setting | Public nursing homes | Primary care health centre | Geriatric institute | Home-based/community centre-based |
Design | RCT, parallel, three-armed | RCT, parallel | RCT, parallel | RCT, parallel |
Aims of the study | To measure dose-response effect of a free weight-based RT program on KE muscle function, functional limitation and self-reported disability. | To determine the effects of a group-based exercise program on ADL and IADL activities relevant to daily life after discharge from hospital | To evaluate the feasibility of upper-body circuit-RT program, and to verify if arm training improves physical outcomes, ADL-function and cognitive outcomes. | To investigate if a 10-week low-intensity strength training program can improve strength of the knee extensors and functional ability in frail elderly. |
Sample size (analyzed), n | IGc: 14, CG: 8 | IG: 26, CG: 30 | IG: 12, CG: 11 | IG: 10, CG: 11 |
Female gender, n | Not reported | IG: 100%, CG: 100% | IG: 100%, CG: 100% | Not reported |
Mean age (SD), years, range | IG1: 83.3 (2.8), IG2: 80.7 (2.3), CG: 80.3 (2.0) | IG: 83.5 (4.1) CG: 82.6 (3.7) | IG: 83,3 (6,7), CG: 84,1 (5,8) | IG: 75.9 (6.8), CG: 77.5 (8.1) |
Participant health status (functional limitation criteria) | Institutionalized. Characterised by authors as frail. Objective measure not reported | Hospitalized due to an acute illness and mobility-impaired | Dependent in one or more ADL (BI), serious mobility limitation, MMSE > 15 < 25 | Difficulty in rising from a chair |
Residential status | Public nursing home | Community-dwelling | Geriatric institute | Residents of assistant living facilities |
Description, intensity, duration and total number of sessions | Classical progressive RT of the KE muscles using ankle cuffs. IG1: 80% 1RM, IG2: 40% 1RM, 10 weeks, 30 sessions | Group based progressive RT with weight training equipment plus functional exercises. 8–10 RM, 10 weeks, 20 sessions | Group based upper body RT program using dumbbells, looped, elastic bands, sticks and sponge balls. Progression by raising number of repetitions and or load | Individually tailored RT program for the KE using bodyweight and elastic band to provide resistance. 9 exercises. 4 RM (elastic band exercises), 10 weeks, 30 sessions |
Control condition | Placebo: similar program with empty ankle cuffs | Instructions for a home exercise training program, including functional exercises. No further encouragement to exercise. | Kept their habits unaltered throughout the study. Were provided physiotherapy as usual | No intervention. Asked to continue with their normal activities |
Self-reported measure of ADL-disability/function | Health Assessment Questionnaire | Tailored ADL/IADL function scale | Barthel Index | The Groningen Activity Restriction Scale (ADL/IADL), lower extremity-specific domain |
Drop-out from intervention, n | Overall: 5 (19%) | IG: 8 (23%), CG: 4 (12%) | IG: 3 (20%), CG: 4 (27%) | IG: 4 (29%), CG: 1 (8%) |
Compliance, % (criteria) | 99% (criteria not stated) | 90%, range 55–100% (mean attendance at sessions) | 75% (SD: 16%) (mean attendance to sessions) | 87% (mean attendance to sessions) |
Direction of the effect on self-reported disability/function | No effect | No effect | Positive effect | Positive effect |
Adverse events | No adverse events | Not reported | No adverse events | No adverse events |
Notes | Two eligible RT-intervention groups. Work load intensity varied between groups. 5 drop outs in total. Number of dropouts on group-level is not reported. | ADL/IADL measured by proxy (health care personnel) | Very frail subjects - many are wheelchair users | |
Data notes | Published and unpublished data. Data from two intervention groups were collapsed in all analysis but the sub-analysis for training intensity | Data not suitable for meta-analysis | ||
Included in primary meta-analysis | Yes | No | Yes | Yes |
Quality assessment/risk of bias in individual studies
Summary measures
Handling of missing data
Synthesis of results
Secondary analysis
Results
Search and study selection
Study characteristics
Resistance training programs
Equipment/external load | Home(H) or Facility-based (F) individual (I) or Group-based (G) | number of RT exercises | Specific muscle groups/lower body/upper body/whole body | Progression protocol | Intensity was based on RM test protocol | Intensity was based on RPE | Supervised by instructor | Training period (weeks) | Training frequency (sessions/week) | Prescribed training volume, (n sessions total) | Session duration in minutes. Total time (incl. Warm-up) / RT time only | Number of sets | Number of repetitions per set | Load intensity (LI) | Estimated LI (%1RM)€ | |
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Ades et al., 2003 [32] | Weights/ dumbbells | F/ND | 8 | Whole body | Yes | Yes | Yes | Yes | 24 | 3 | 72 | ND | 1–2 | 10 | 80% 1RM | 80 |
Benavent-Caballer et al., 2014 [33] | Ankle cuffs | F/I | ND | KE | Yes | Yes | No | Yes | 16 | 3 | 48 | 30–35 / - | 3 | 15 | 40% 1RM | 40 |
Binder et al., 2002 [15] | Free weights/ machines | F/G | 6 | Whole body | Yes | Yes | No | Yes | 12 | 3 | 36 | ND | 3 | 8–12 | 65–100% 1RM | 82.5 |
Boshuizen et al., 2005 [34] | Body weight/ elastic bands | H + F/G | 9 | Lower body | Yes# | No | No | Yes*** | 10 | 3 | 30 | ND | 3 | 4–8 | 4–8 RM (elastic band exercises) | 85 |
Buchner et al., 1997 [35] | Machines | F/G | 9 | Whole body | No | Yes | No | Yes | 24 | 3 | 72 | 60 / 35–45 | 2 | 10 | 1st set: 50–60% 1RM. 2nd set: 75% 1RM | 62.5 |
Cadore et al., 2014 [36] | Machines | F/ND | 3 | KE + chest | Yes | Yes | No | Yes | 12 | 2 | 24 | 40 / 20 | ND | 8–10 | 40–60% 1 RM | 50 |
Chandler et al., 1998 [16] | Body weight/ elastic bands | H/I | 8 | Lower body | Yes | No | No | Yes | 10 | 3 | 30 | ND | 2 | 10 | 10 RM (elastic band) | 75 |
Chin a Pow et al., 2006 [37] | Machines/ free weights/cuff weights | F/G | 5 | Whole Body | Yes | No | No | Yes* | 24 | 2 | 48 | 45–60 / - | 2 | 12 | 60–80% 1RM | 70 |
Clemson et al., 2012 [38] | Ankle cuffs | H/I | 6 | Lower body | Yes | No | No | No | 52 | 3 | 156 | ND | ND | ND | ND | ND |
Danilovich et al., 2016 [39] | Elastic bands | H/I | 11 | Whole body | Yes | No | No | Yes** | 12 | 3 | 36 | 35 / 25 | 1 | max 10 | “Moderate” | low/ mod |
Fahlman et al., 2007 [40] | Elastic bands | ND/ND | 13 | Whole body | Yes | No | Yes | No | 16 | 3 | 48 | ND | 2 | 12 | To mild fatigue § | low/ mod |
Hewitt et al., 2018 [41] | Pneumatic machines | F/G | 5 | Whole body | Yes | No | Yes | Yes | 25 | 2 | 50 | 60 / - | 3 | 10 | 12–14(Borg) | mod |
Latham et al., 2003 [42] | Ankle cuffs | H/I | 1 | KE | Yes | Yes | No | Once weekly | 10 | 3 | 30 | ND | 3 | 8 | 50% 1RM | 50 |
McMurdo & Johnstone 1995 [43] | Elastic bands | H/I | 24 | Whole body | No | No | No | once monthly | 24 | 7 | 168 | 15 / - | 1 | 5–10 | ND | ND |
Mihalko & McAuley 1996 [44] | Dumbbells | F/ND | 5 | Upper body | Yes | Yes | No | Yes | 8 | 3 | 24 | 30 / - | ND | 10–12 | 10–12 RM | 70 |
Sahin et al., 2018 [45] | Ankle cuffs, dumbbells | ND/ND | 11 | Whole body | No | No | No | Yes | 8 | 3 | 24 | 40 / 20 | 1 | 6–10 | IG1: 70% 1RM, IG2: 40% 1RM | 40,70 |
Seynnes et al., 2004 [17] | Ankle cuffs | ND/ND | ND | KE | Yes | Yes | No | Yes | 10 | 3 | 30 | ND | 3 | 8 | IG1: 80% 1RM, IG2: 40% 1RM | 40, 80 |
Timonen et al., 2006 [46] | Machines | F/G | ND | Lower body | No | No | No | Yes | 10 | 2 | 20 | 90 / 30 | 2 | 8–10 | 8–10 RM | 80 |
Venturelli 2010 [47] | Elastic bands/ barbells | F/G | ND | Upper body | Yes | Yes | No | Yes | 12 | 3 | 36 | 45 / 25 | 3 | 20 | 50% 1RM | 50 |
Westhoff et al., 2000 [18] | Body weight/ elastic bands | F + H/ND | 9 | KE | Yes # | No | No | Yes*** | 10 | 3 | 30 | 60 / 40 | 1–3 | 4–8 | 4–8 RM (elastic band) | 85 |
Primary outcome - self-reported ADL-function/disability
Secondary outcomes - objective study outcomes
Risk of bias within studies
Rating of methodological quality
Ades et al., 2003a [32] | Benavent-Caballer et al., 2014a [33] | Binder et al., 2002a [15] | Boshuizen et al., 2005a [34] | Buchner et al., 1997a [35] | Cadore et al., 2014a [36] | Chandler et al., 1998b [16] | Chin a Pow et al., 2006a [37] | Clemson et al., 2012b [38] | Danilovich et al., 2016 a [39] | Fahlman et al., 2007b [40] | Hewitt et al., 2018b [41] | Latham et al., 2003b [42] | McMurdo & Johnstone 1995a [43] | Mihalko & McAuley 1996a [44] | Sahin et al., 2018a [45] | Seynnes et al., 2004a [17] | Timonen et al., 2006b [46] | Venturelli et al., 2010a [47] | Westhoff et al., 2000a [18] | |
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1. Eligibility criteria were specified (external validity) | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
2. subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received) | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Yc | Y | Y | Y | Y | Y | Y | Y | Y |
3. Allocation was concealed | N | N | Y | N | N | Y | Y | Y | Y | Y | N | Y | N | Y | N | N | N | N | N | Y |
4. The groups were similar at baseline regarding the most important prognostic indicators | Y | Na | Y | Y | Y | Y | Y | Y | Y | Y | N | Nb | Y | Y | Nb | Y | Y | Y | Nb | Y |
5. There was blinding of all subjects | Y | N | Y | N | N | N | N | Y | Y | N | N | N | Y | Y | Y | Y | Y | Y | N | N |
6. There was blinding of all therapists who administered the therapy | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N |
7. There was blinding of all assessors who measured at least one key outcome | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | N | N | Y | N | Y | Y |
8. Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups | N | Y | Y | N | Y | N | Y | N | N | Y | N | Y | Y | N | Y | Y | Y | N | N | N |
9. All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by “intention-to-treat” | N | Y | N | N | Y | Y | N | N | Y | Y | N | Y | Y | Y | Y | Y | N | N | Y | N |
10. The results of between-group statistical comparisons are reported for at least one key outcome | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
11. The study provides both point measures and measures of variability for at least one key outcome | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Total score for internal validity (item 2–15) | 5 | 6 | 8 | 5 | 7 | 7 | 7 | 7 | 8 | 8 | 3 | 6 | 8 | 8 | 6 | 6 | 7 | 5 | 5 | 6 |
Risk of bias across studies
Publication bias
Results of individual studies and synthesis of results
Primary analysis - pooled effects of RT on self-reported disability
Summary statistics | Heterogeneity statistics | ||||||||
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N | SMD | 95% CI low | 95% CI high | p-value | Q-stat | d.f | Q-stat. p-value | I2% | |
Effect of RT on self-reported disability | 14 | 0.589 | 0.253 | 0.925 | 0.001 | 52.26 | 13 | < 0.001 | 75.1 |
Effect of RT on gait capacity | 9 | 0.36 | −0.016 | 0.73 | 0.061 | 21.96 | 8 | 0.005 | 63.6 |
Effect of RT on lower body functional capacity | 12 | 0.625 | 0.223 | 1.026 | 0.002 | 54.42 | 11 | < 0.001 | 79.8 |
Effect of RT on knee extensor strength | 9 | 0.970 | 0.456 | 1.485 | < 0.001 | 48.22 | 8 | < 0.001 | 83.4 |
Complementary analysis – vote-count procedure
Secondary analysis
Investigation of between-study heterogeneity
Summary statistics | Heterogeneity statistics | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
95% CI | 95% CI | Weight | Q-stat. | ||||||||
Variable | Sub-group | N | SMD | low | high | % | p-value | Q-stat | d.f | p-value | I2% |
Overall effect of RT on self-reported disability | 14 | 0.589 | 0.253 | 0.925 | 100.00 | 0.001 | 52.26 | 13 | < 0.001 | 75.1 | |
Participant characteristics | |||||||||||
Participant mean age | < 80 years | 5 | 0.106 | −0.192 | 0.404 | 35.3 | 0.485 | 4.12 | 4 | 0.390 | 2.9 |
≥80 years | 9 | 0.830 | 0.381 | 1.280 | 64.7 | 0.001 | 38.99 | 8 | < 0.001 | 79.5 | |
Residential status | CD | 4 | 0.163 | −0.194 | 0.520 | 30.8 | 0.370 | 5.00 | 3 | 0.172 | 40.0 |
SH | 3 | 0.262 | −0.199 | 0.723 | 21.1 | 0.265 | 2.91 | 2 | 0.233 | 31.1 | |
GI | 7 | 1.027 | 0.438 | 1.617 | 48.1 | 0.001 | 31.67 | 6 | < 0.001 | 81.1 | |
Gait speed at baseline | ≥ 0.8 m/s | 4 | 0.154 | −0.233 | 0.540 | 33.2 | 0.436 | 5.48 | 3 | 0.140 | 45.2 |
< 0.8 m/s | 9 | 0.829 | 0.312 | 1.346 | 66.8 | 0.002 | 37.77 | 8 | < 0.001 | 78.8 | |
Resistance training modalities | |||||||||||
Work load intensity** | < 70%1RM | 7 | 0.843 | 0.222 | 1.464 | 40.7 | 0.008 | 25.74 | 6 | < 0.001 | 76.7 |
≥70% 1RM | 8 | 0.580 | 0.185 | 0.975 | 51.8 | 0.004 | 20.72 | 7 | 0.004 | 66.2 | |
ND | 1 | 0.000 | −0.566 | 0.566 | 7.5 | – | – | 0 | – | – | |
Frequency, sessions/week | 3 | 11 | 0.669 | 0.272 | 1.067 | 78.0 | 0.001 | 42.69 | 10 | < 0.001 | 76.6 |
2 | 2 | 0.515 | −0.566 | 1.596 | 14.3 | 0.350 | 4.79 | 1 | 0.029 | 79.1 | |
7 | 1 | 0.000 | −0.566 | 0.566 | 7.8 | – | – | 0 | – | – | |
Study quality parameters | |||||||||||
Allocation concealment | Yes | 6 | 0.352 | 0.011 | 0.693 | 43.7 | 0.043 | 9.84 | 5 | 0.08 | 49.2 |
No | 8 | 0.761 | 0.207 | 1.316 | 56.3 | 0.007 | 39.00 | 7 | < 0.001 | 82.1 | |
Groups were similar at baseline | Yes | 11 | 0.506 | 0.102 | 0.911 | 78.1 | 0.014 | 45.64 | 10 | < 0.001 | 78.1 |
No | 3 | 0.873 | 0.515 | 1.231 | 21.9 | < 0.001 | 0.88 | 2 | 0.645 | 0.0 | |
Subjects were blinded | Yes | 7 | 0.651 | 0.107 | 1.195 | 51.9 | 0.019 | 37.25 | 6 | < 0.001 | 83.9 |
No | 7 | 0.522 | 0.109 | 0.935 | 48.1 | 0.013 | 14.86 | 6 | 0.021 | 59.6 | |
Assessors were blinded | Yes | 11 | 0.421 | 0.150 | 0.639 | 78.8 | 0.002 | 20.84 | 10 | 0.022 | 52.0 |
No | 3 | 1.128 | −0.215 | 2.472 | 21.2 | 0.100 | 23.90 | 2 | < 0.001 | 96.6 | |
End point data on 85% of the participants was obtained | Yes | 7 | 0.743 | 0.194 | 1.293 | 51.2 | 0.008 | 35.24 | 6 | < 0.001 | 83.0 |
No | 7 | 0.409 | 0.028 | 0.791 | 48.8 | 0.036 | 13.63 | 6 | 0.034 | 56.0 | |
Intention-to-treat analysis were performed | Yes | 8 | 0.764 | 0.191 | 1.337 | 56.8 | 0.009 | 42.75 | 7 | < 0.001 | 83.6 |
No | 6 | 0.349 | 0.065 | 0.633 | 43.3 | 0.016 | 6.86 | 5 | 0.231 | 27.2 |
Covariate | Coeffi-cient | Standard error | 95% lower CI | 95% upper CI | t-value | p-value | Adj.R2% | I2 res., % | N |
---|---|---|---|---|---|---|---|---|---|
Participant characteristics | |||||||||
Mean age (years, continuous) | 0.088 | 0.03 | 0.01 | 0.16 | 2.51 | 0.027 | 43.7 | 64.8 | 14 |
Gait speed at baseline (< 0.8 / ≥0.8 m*s−1) | 0.679 | 0.43 | −0.27 | 1.63 | 1.58 | 0.143 | 13.4 | 75.6 | 13 |
Resistance training program modality | |||||||||
Program duration (weeks, continuous) | −0.074 | 0.03 | −0.14 | −0.01 | −2.62 | 0.024 | 65.1 | 44.9 | 13 |
aWork load intensity (% 1RM, continuous) | −0.019 | 0.01 | −0.05 | 0.01 | −1.61 | 0.134 | 18.2 | 68.6 | 14 |
Resistance training effects on | |||||||||
Knee-extensor strength (SMD) | 0.341 | 0.24 | −0.22 | 0.91 | 1.43 | 0.196 | 18.1 | 78.1 | 9 |
Lower body functional capacity (SMD) | 0.772 | 0.13 | 0.49 | 1.06 | 6.06 | < 0.001 | 99.2 | 0.0 | 12 |
Gait capacity (SMD) | 0.365 | 0.23 | −0.17 | 0.90 | 1.61 | 0.152 | 57.5 | 32.9 | 9 |