Introduction
Methods
Search strategy
Inclusion criteria
Procedures
Results
Study | Study sample | Randomization | Dropouts | Frailty criteria |
---|---|---|---|---|
Alexander et al. [39] |
n = 161 community-dwelling elderly (≥65 years, mean age 82 years) | Exercise group (EG) = 81 persons and Control group (CG) = 80 |
n = 37, EG = 21, and CG = 16 | Requiring assistance in performing ≥1 mobility-related ADL(transferring, walking, bathing, and going to the toilet) |
Binder et al. [14] |
n = 119 (115 followed-up) community-dwelling older adults (≥78 years, mean age of 83 ± 4 years) | 3:2 ratio (EG and CG, respectively); EG = 69 and CG = 50 |
n = 32, CG = 9, and EG = 23 | Mild to moderate frailty—meeting ≥2 indicators: (1) score between 12 and 32 on the modified physical performance test (PPT); (2) difficulty or need ≥2 IADL or 1 ADL; and (3) VO2 peak between 10 and 18 ml/kg/min |
Binder et al. [37] |
n = 90 (85 followed-up) community-dwelling older adults (≥65 years) with proximal femur fracture (within 16 weeks from screening evaluation) | Within strata based on surgical repair procedure; CG = 44 and EG = 46 |
n = 22, CG = 8, and EG = 14 | Modified PPT score between 12 and 28 and self-reported difficulty or requirement for assistance with ≥1 ADL |
Brown et al. [15] |
n = 87 (men = 37) community-dwelling independent-living (but with difficulty) older adults (≥78 years, mean age 83 ± 4 years) | EG = 48 and CG = 39 | PPT Score between 18 and 31 (extreme values included) | |
Chin A Paw et al. [16] |
n = 217 (70% women) community-dwelling elderly (≥70 years, mean age of 78.7) | Placebo-controlled intervention based on a 2 × 2 factorial design; EG (n = 55); a group receiving enriched foods (EF, n = 58); EG + EF (n = 60); or CG (n = 44) |
n = 56, 26–29% in intervention groups and 16% in CG | inactivity (weekly ≥30 min of brisk walking, cycling, and gymnastics) and involuntary weight loss or a body mass index (BMI) below average |
Chin A Paw et al. [17] |
n = 139 community-dwelling independent-living elderly (≥70 years, mean age 78.5 ± 5.7) | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | |
de Jong et al. [18] |
n = 143 community-dwelling independent-living elderly (≥70 years, mean age 78.6 ± 5.6) | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | |
Dorner et al. [27] |
n = 42 long-term facility care residents(≥75 years, mean age 86.8 ± 5.8) | Within strata based on sex, age, mini mental state exam score, and strength (EG = 21 and CG = 21) |
n = 12, EG = 6, and CG = 6 | Impaired mobility (Tinetti score) |
Ehsani et al. [19] |
n = 46 older adults extracted from Binder et al. 2002 | EG = 22 (83 ± 3.6 years) who had increased their aerobic capacity due to training and CG = 24 (84 ± 4.2 years) | Binder et al. [14] | |
Faber et al. [20] |
n = 278 (79% women) residents of self-care and nursing care residences (63–98 years old, mean age 84.9 ± 6 years) | Long-term care centers were randomized to one of the two exercise programs; participants of each center were randomized to EG and CG |
n = 40 | Meeting ≥3 frailty indicators (≤2 for prefrailty): (1)unintentional weight loss, (2)weakness, (3)exhaustion, (4)slowness, and (5)low physical activity |
Gill et al. [21] |
n = 188 elderly (≥75 years, mean age 83 years) who lived at home | Within strata based on the level of physical frailty; EG = 94 and CG = 94 |
n = 43, EG = 33, and CG = 10 | Meeting one (moderate) or two (severe) frailty indicators: (1) requiring more than 10 s to perform a gait test and (2) not being able to stand up from a seated position with their arms folded |
Gill et al. [40] | see Gill et al. [21] | see Gill et al. [21] | see Gill et al. [21] | see Gill et al. [21] |
Greenspan et al. [22] |
n = 267 transitionally frail older women (≥70 years); residents of independent-living facilities | EG = 148 and CG = 143 |
n = 86, EG = 45, and CG = 41 | Speechley and Tinetti (1991) criteria based on age, gait, and balance, walking activity for exercise, other physical activity for exercise, presence or absence of depression, use of sedatives, near–vision status, upper and lower extremity strength, and lower extremity disability |
Greiwe et al. [23] |
n = 13 older adults (>75 years) | EG = 8 and CG = 5 |
n = 0 | Based on functional fitness tests |
Jensen et al. [28] |
n = 187(75% women) elderly (65–98 years; median age 84) living in care facilities | Cluster randomization of the facility care residences with EG = 89 and CG = 98 |
n = 35, EG = 12, and CG = 23 | being most prone to falls (mobility interaction fall chart) |
Latham et al. [24] |
n = 243 elderly (≥65 years; mean age 79.1 ± 6.9 years) | 2 × 2 stratified block randomization technique (6/block): EG = 120 and CG = 123; and Vitamin = 121, and placebo = 122 |
n = 21, EG = 8, and CG = 13 | Based on Winograd et al. (1991) criteria, i.e., meeting ≥1 indicators: (1) dependency in ADL; (2) prolonged bed rest; (3) impaired mobility; and (4) recent fall |
Miller et al. [38] |
n = 100 older patients (≥70 years; mean age 84 years) from a medical center | Stratified (community or residential care), block randomization method (blocks of 12): EG = 25, Nutritional Supplement (NS = 25), EG + NS = 24, and CG = 26 |
n = 7, EG = 2, NS = 2, EG + NS = 2, and CG = 1 | Fall-related fracture of the lower limb and being proxy for low nutritional status (midarm circumference <25th percentile) |
Rosendahl et al. [41] |
n = 191 older adults (≥65 years; mean age 84.7 ± 6.5), residents of care facilities | stratified cluster-randomized, with a 2 × 2 model: CG = 50, EG = 45, EG + Protein (EG + P) = 46, and CG + P = 50 |
n = 28, EG + P = 5, EG = 9, CG = 5, and CG + P = 9 | being dependent in ≥1 ADL |
Rydwik et al. [29] |
n = 96 community-dwelling elderly (>75 years) | Consecutive randomization in batches; started with the oldest individual: Nutrition (N, n = 25), EG = 23, EG + N = 25, and CG = 23 |
n = 31, EG = 4, EG + N = 11, N = 7, and CG = 9 | Unintentional weight loss ≥5% and/or BMI ≤ 20 and low physical activity level |
Sattin et al. [25] |
n = 311 (n = 20 men) transitionally frail elderly (70–97 years; mean age 80.9 years), residents of independent-living facilities | EG = 158 and CG = 153 |
n = 94, EG = 49, and CG = 44 | see Greenspan et al. [22] |
Seynnes et al. [35] |
n = 27 older adults (≥70 years); nursing home residents | Strata based on 1RM values: High intensity (EG-HI, n = 8), Low intensity (EG-LI, n = 6), or CG = 8 |
n = 5 | being a nursing home resident with a knee extension <10 kg (1RM) |
Shimada et al. [30] |
n = 34 older adults (67–91 years, mean age 80.8 ± 6.6 years), attending a care facility | strata based on the ability to walk outdoors without help: EG-B(balance exercise = 12), EG-G (gait training = 12), and CG = 10 |
n = 2, CG = 1, and EG-G = 1 | Living in/or utilizing a day-care program; subjects had a certification of long-term care need by the Japanese public nursing care insurance system for frailty |
Timonen et al. [33] |
n = 68 older women (≥75 years; mean age 83 ± 3.9 years) discharged from an acute hospital ward | EG (n = 34) and CG (n = 34) |
n = 16, EG = 10, and CG = 6 | difficulties in mobility and balance and tendency to fall when walking unassisted during an acute disease |
Timonen et al. [32] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] |
Timonen et al. [31] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] |
Wolf et al. [26] | see Sattin et al. [25] | see Sattin et al. [25] | see Sattin et al. [25] | see Greenspan et al. [22] |
Wolf et al. [34] |
n = 200 (19% of men) community-dwelling older adults (≥70 years) | 2 EGs (tai chi, TC = 72 and balance training, BT = 64) and one CG (n = 64). Randomization in cohorts of 32 (BT = 10, CG = 10, and TC = 12) for each of the first four cohorts; the last two were randomized in cohorts of 36 (12 subjects to each group) |
n = 13, TC = 6, BT = 4, and CG = 3 | see Greenspan et al. [22] |
Wolf et al. [36] | see Sattin et al. [25] | see Sattin et al. [25] | see Sattin et al. [25] | see Greenspan et al. [22] |
Study | Exercise program | Study follow-up and intervention length | Control group characteristics | Training principles |
---|---|---|---|---|
Binder et al. [14] | Supervised multicomponent training (flexibility, balance, coordination, speed of reaction, strength, and endurance), three times per week during 9 months | 9 months | Low-intensity home-based training (flexibility); 1 h/session, two to three times per week for 9 months | Frequency, duration, intensity, progression, individualization, and specificity |
Ehsani et al. [19] | see Binder et al. [14] | see Binder et al. [14] | see Binder et al. [14] | progression, individualization, frequency, duration, intensity, and specificity |
Brown et al. [15] | Supervised low-intensity multicomponent training, three times per week for 3 months (flexibility, balance, body handling skills, speed of reaction, coordination, and strength) | 3 months | Low-intesity home-based exercise (flexibility); 1 h/session, three times per week for 3 months | Progression, frequency, individualization, and specificity |
Jensen et al. [28] | 11-week supervised multicomponent exercise program (balance, ambulation, strength, endurance, flexibility, and safe movement behavior) executed, in general, two to three times per week, 1–3 h/week | 11-week intervention, 9-month follow-up | Usual care | Progression, individualization, intensity, duration, frequency, and specificity |
Rydwik et al. [29] | Supervised multicomponent exercise program (endurance, strength, and balance), 1 h/session, two times per week for 12 weeks | 3-month intervention, 9-month follow-up | General advice on physical training and diet | Progression, individualization, intensity, duration, frequecy, and specificity |
Timonen et al. [33] | Supervised multicomponent exercise program (resistance training and functional exercises), two times per week, 90 min/session, for 10 weeks | 10-month intervention, 9-month follow-up after intervention | Requested to perform a home-based functional exercise program, two to three times per week | |
Timonen et al. [32] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] | Progression, individualization, intensity, duration, frequency, and specificity |
Timonen et al. [31] | see Timonen et al. [33] | see Timonen et al. [33] | see Timonen et al. [33] | Progression, individualization, intensity, duration, frequency, and specificity |
Binder et al. [37] | 6 months of supervised multicomponent training (flexibility, balance, coordination, movement speed, strength, and endurance), 45–90 min/session (with possible breaks), three times per week | 6 months | Low-intesity home-based exercise (flexibility); 1 h/session three times per week for 6 months | Progression, individualization frequency, specificity, and duration |
Greenspan et al. [22] | Supervised tai chi exercise (trunk rotation, weight shifting, coordination, and gradual narrowing of the lower extremity stance), two times per week from 10 to 50 min for 48 weeks | 48 weeks | wellness educational program (instructions on falls-prevention, exercise, balance diet, and nutrition) 1 h/week | |
Sattin et al. [25] | see Greenspan et al. [22] | see Greenspan et al. [22] | see Greenspan et al. [22] | |
Wolf et al. [26] | see Greenspan et al. [22] | see Greenspan et al. [22] | see Greenspan et al. [22] | Progression, individualization, duration, frequency, and specificity |
Wolf et al. [36] | see Greenspan et al. [22] | see Greenspan et al. [22] | see Greenspan et al. [22] | Progression, individualization, frequency, duration, and specificity (for some measures) |
Wolf et al. [34] | 15 weeks of supervised tai chi (two times per week; subjects were requested to try two times per day for 15 min—not monitored) or balance training (once per week) | 15-month intervention; 4-month after follow-up | Discussions with a nurse (e.g., sleep disorders), once a week, 1 h/session for 15 weeks | Progression, frequency individualization, and specificity |
Greiwe et al. [23] | Supervised resistance training program, three times per week for 3 months, 50–90 min/session | 3 months | Light stretching program for 3 months | |
Latham et al. [24] | Home-based resistance quadriceps exercise (ankle cuff weights), three times per week during 10 weeks | 10-month intervention, 6-month follow-up | Frequency-matched telephone calls and home visits | Individualization, specificity, intensity, and frequency |
Dorner et al. [27] | three times per week, 50 min/session, of a supervised resistance exercise program focused on strength and balance | 10 weeks | Frequency, duration, and specificity | |
Seynnes et al. [35] | Supervised 10-week resistance training (knee muscles), three times per week | 10 weeks | Placebo exercise (empty cuff weights) | Progression, individualization, intensity, frequency, and specificity |
Miller et al. [38] | Supervised resistance training (hip extensors and abductors, knee extensors, ankle dorsi, and plantar-flexors), three times per week, 20–30 min/session for 12 weeks | 12 weeks | Usual care. matched visits (“attention effect”), three times per week (weeks 1–6); and once a week (weeks 7–12) | Progression, individualization, intensity, duration, frequency, and specificity |
Chin A Paw et al. [16] | Supervised skills training program, two times per week for 17 weeks, 45 min/session (focused on strength, speed, endurance, flexibility, and coordination) | 17 weeks | social program, once or twice a week, 90 min/session (adjustment for socializing and attention effects) | Progression, individualization, duration, frequency, intesity, and specificity |
Chin A Paw et al. [17] | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | |
de Jong et al. [18] | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | see Chin A Paw et al. [16] | |
Alexander et al. [39] | Supervised bed- and chair-rise task-specific training with emphasis on strength and range of motion (proximal upper and lower extremity, musculature, and trunk), performed for 12 weeks, three times per week, 1 h/session | 12 weeks | 12-week exercise program focused on flexibility, three times per week, 1 h/session | Progression, individualization, intensity, frequency, duration, and specificity |
Rosendahl et al. [41] | Supervised functional exercise program (everyday tasks challenging leg strength, postural stability, and gait ability) with 45 min/session, five times every 2 weeks for 3 months | 3-month intervention and 6-month follow-up | Social activities (watching films, reading, singing, and conversation) | Progression, individualization, frequency, duration, intensity, and specificity |
Faber et al. [20] | Supervised fall-preventive exercise programs (focused on balance and functional strength, and/or tai chi principles), 60 min/session, once a week for 4 weeks, and two times per week for 16 weeks. | 20-week intervention and 52-week follow-up | Progression, individualization, duration, frequency, and specificity | |
Gill et al. [21] | 6-month home-based exercise program (balance once a day and leg and arm-conditioning and strengthening three times per week); participants received in average 14.9 visits of a physical therapist | 6-month intervention and 12-month follow-up | educational program (attention and health education), 45–60 min/session for 6 months, with visits of a health educator | Individualization, specificity, and frequency |
Gill et al. [40] | see Gill et al. [21] | see Gill et al. [21] | see Gill et al. [21] | Individualization, specificity, and frequency |
Shimada et al. [30] | Two supervised exercise training (balance and gait training), two to three times per week during 40 min/session, for 12 weeks | 12 weeks | Usual care | Individualization, duration, frequency, and specificity |
Study | Main outcome measures | Results (main outcome) | Secondary outcome measures | Results (secondary outcome) |
---|---|---|---|---|
Gill et al. [21] | Summary disability score (performance in ADLs) | Compared with CG subjects, EG ones improved: disability scores (moderately frail subgroup) | Admission to and number of days spent in a nursing home | No differences were achieved |
Timonen et al. [31] | ADL and IADL levels (Joensuu classification) | No differences were achieved | ||
Binder et al. [37] | Modified PPT, functional status questionnaire (FSQ), and ADL instruments | Compared with CG subjects, EG ones improved: modified PPT score, and FSQ score | Strength knee extension (KET) and flexion torque (KFT); gait; balance (progressive Romerg Test, Berg balance Test (BBT), and single-limb stance); body composition; quality of life (SF-36), and a modified hip rating questionnaire (HRQ) | Compared with CG subjects, EG ones improved: KET (both limbs), 1RM (knee extension and flexion, seated bench press, seated row, leg press, and biceps curl), fast walking speed, Berg balance score, single-limb stance time (fractured leg), HRQ score, and the change in health and physical function subscale scores of the SF-36 |
Gill et al. [40] | Self-reported IADLs; mobility (modified performance oriented mobility assessment—POMA); timed rapid gait and chair stands; and modified PPT | Compared with CG subjects, EG ones improved: IADL, timed rapid gait, mobility, timed chair stands, and modified PPT | ||
Dorner et al. [27] | Muscle function, cognitive function (MMSE) | Compared with CG subjects, EG ones improved: muscle function | Lean body mass, ADLs, mobility (Tinetti score), and depression | Compared with CG subjects, EG ones improved: LBM |
Alexander et al. [39] | Bed- and chair-rise task performance ability and time taken to rise | Compared with CG subjects, EG ones improved: bed- and chair-rise task performance ability and time taken to rise | strength, range of motion (ROM), and trunk lateral balance | Compared with CG subjects, EG ones improved: trunk lateral balance, ROM, and strength (mainly in trunk region) |
Jensen et al. [28] | Ambulation (functional ambulations category scale), usual, and maximum gait speed, balance (BBT), and step height. | Compared with CG subjects, EG ones improved: step height and ambulation (not decreased), usual, and maximum gait speed | Risk of falling | No differences were achieved |
Shimada et al. [30] | Balance (one leg standing, functional reach, manual perturbation test, functional balance scale, and POMA) and gait (timed up-and-go [TUG], and stair climbing/descending) | Compared with CG subjects, EG ones improved: balance | ||
Wolf et al. [36] | FF (e.g., gait speed, functional reach test, timed chair–stand, timed 360°–turn, and single limb stance) | Compared with CG subjects, EG ones improved: chair–stand (after 4 and 8-month training) | Height, weight, BMI, Systolic, diastolic blood pressure, and resting heart rate | Compared with CG subjects, EG ones improved: BMI, SBP, and resting heart rate |
Binder et al. [14] | Modified PPT, VO2 peak, and ADL measures (FSQ) | Compared with CG subjects, EG ones improved: modified PPT score, VO2 peak, and FSQ score | KET and KFT; balance (leg stance time, and BBT); change health subscale of SF-36; and weight | Compared with CG subjects, EG ones improved: KET, KFT, balance (one leg stance time and BBT), and change in health subscale SF-36 |
Brown et al. [15] | PPT, balance, gait, strength, flexibility, speed of reaction, and coordination, peripheral sensation | Compared with CG subjects, EG ones improved: PPT score, stregth, balance, and gait | ||
Chin A Paw et al. [16] | FF tests (e.g., balance and gait speed), physical fitness (e.g., strength, flexibility, and reaction time), self-rated disabilities in ADLs | Compared with CG subjects, EG ones improved: FF score (mainly chair–stand, touching toes, and walking speed) and physical performance when adjusted for baseline scores | ||
Rydwik et al. [29] | Muscle strength, FF (30-second chair–stand, balance tandem and one leg stance, TUG, and gait speed), ADLs (functional independence measure), and IADLs (instrumental activity measures) | Compared with CG subjects, EG ones improved: strength; no differences persisted achieved 9 months after randomization | ||
Timonen et al. [32] | Knee (KET) and hip abduction strength, balance (14-item BBT), and maximal walking speed | Compared with CG subjects, EG ones improved: hip abduction strength, KET, balance, and walking speed | ||
Wolf et al. [34] | Strength, flexibility, cardiovascular endurance, body composition, IADL score, depression, and fear of falling | Compared with CG subjects, EG ones improved: left handgrip strength and systolic blood pressure (TC group); however, TC exercisers reduced the distance ambulated (cardiovascular endurance) | Time-specific risk for falls | No differences were achieved |
Miller et al. [38] | Weight, quadriceps strength, usual gait speed, and quality of life (SF-12) | No differences were achieved | ||
Rosendahl et al. [41] | Balance (BBT), gait, and lower limb strength (1RM or chair–stand) | Compared with CG subjects, EG ones improved: usual gait speed, balance, and lower-limb strength | ||
de Jong et al. [18] | Body composition (dual–energy X-ray absorptiometry) | Compared with CG subjects, EG ones improved: lean body mass; exercise had no effect on bone parameters | Weight, BMI, waist and hip, and waist-to-hip circumferences | No differences were achieved |
Ehsani et al. [19] | Maximal cardiac output (heart rate, left ventricular [LV] function), arteriovenous O2 content difference | Compared with CG sujects, EG ones improved: cardiac output, LV stroke work (peak effort) and peak heart rate | Body composition LBM and weight | Compared with CG sujects, EG Ones improved: LBM |
Greiwe et al. [23] | Cytokine tumor necrosis factor α (TNF-α) level, protein synthesis rate, and lipoprotein lipase (LPL) | EG had decreased skeletal muscle TNF-α and increased LPL expression and protein synthesis rate | ||
Seynnes et al. [35] | Knee extension strength (KET) | Compared with CG subjects and EG ones improved: KET | Functional limitations (6-min walking, chair-rising, and stair climbing) and self-reported disability (French version of health assessment questionnaire and disability index subscale) | Compared with CG subjects, EG ones improved: 6-min walking (just for EG-HI), chair-rising, and stair climbing |
Chin A Paw et al. [17] | Subjective well being (subscales: health, self-respect, morale, optimism, and contacts) | No differences were achieved | Self-rated health | No differences were achieved |
Greenspan et al.[22] | Perceived health status (sickness impact profile) and self-rated health | Compared with CG subjects and EG ones improved: perceived health status (physical dimension, mainly, ambulatory category) | ||
Sattin et al. [25] | Fear of falling (Activities-Specific Balance Confidence Scale [ABC], and fall efficacy scale) | Compared with CG subjects and EG ones improved: fear of falling (ABC) | ||
Timonen et al. [33] | mood (Zung self-rating depression scale) | Compared with CG subjects and EG ones improved: mood | ||
Latham et al. [24] | Self-rated physical health (physical component of the SF-36) and risk of falls | No differences were achieved | ADL, physical performance (strength, balance, mobility, and gait speed), FF, fear of falling, social activities, and mental health | No differences were achieved |
Faber et al. [20] | Fall risk | Fall risk in prefrail subjects (EGs) decreased but it increased in frail elderly (EGs) | mobility (POMA) and FF and self-reported disability (ADL, and IADL) | Compared with CG subjects and EG ones improved: mobility (POMA score) and FF (prefrail subgroup); FF decreased in frail subgroup (EG) |
Wolf et al. [26] | Fall risk | EG presented lower fall risk from months 4 to 12 |