Key Points
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Low-intensity exercise offers both physical and cognitive health benefits to older adults.
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Low-intensity exercise is useful to induce health benefits for high-risk population such as physical frail older adults.
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Low-intensity exercise induces better exercise adherence as relative to moderate and high intensity exercise.
Background
Methods
Information Sources
Search Strategy and Data Items
Eligibility Criteria and Study Selection
Data Extraction and Quality Assessment
Data Synthesis
Results
Search Results
Quality Assessment
Study | Reporting | External validity | Internal validity—bias | Internal validity—confounding | Power | QI score |
---|---|---|---|---|---|---|
Full score, 11 | Full score, 3 | Full score, 7 | Full score, 6 | Full score, 1 | Full score, 28 | |
Blair et al., 2014 [54] | 7 | 2 | 5 | 4 | 0 | 18 |
Brown et al., 2000 [55] | 8 | 3 | 5 | 3 | 0 | 19 |
Dawe et al., 1995 [56] | 7 | 3 | 5 | 4 | 0 | 19 |
DeVito et al., 2003 [57] | 6 | 3 | 5 | 2 | 0 | 16 |
Lam et al., 2011 [58] | 8 | 2 | 4 | 3 | 0 | 17 |
Li et al., 2005 [59] | 8 | 3 | 5 | 2 | 0 | 18 |
Mangione et al., 1999 [60] | 8 | 3 | 5 | 3 | 0 | 19 |
Means et al., 1996 [61] | 9 | 3 | 4 | 2 | 0 | 18 |
Morey et al., 2009 [62] | 7 | 2 | 6 | 3 | 0 | 18 |
Morgan et al., 2004 [63] | 8 | 3 | 5 | 3 | 0 | 19 |
Motl et al., 2005 [64] | 6 | 3 | 4 | 2 | 0 | 15 |
Rosie et al., 2007 [65] | 9 | 3 | 5 | 2 | 0 | 19 |
Schnelle et al., 2003 [66] | 8 | 3 | 6 | 3 | 0 | 20 |
Singh et al., 2005 [67] | 8 | 3 | 6 | 3 | 0 | 20 |
Wolfson et al., 1996 [68] | 9 | 3 | 5 | 3 | 0 | 20 |
Study Characteristics
Study | Domain | Design | Sample | Intervention | Key outcomes | Results |
---|---|---|---|---|---|---|
Dawe et al., 1995 [56] | Cognitive health | Pre-post test |
N = 20 | Duration, 1 h | Blood pressure = mmHg | Intervention group = significantly increased pulse rate (from 69.2 to 71.2 beats/min) and blood pressure (from 140/75 to 145/73 mmHg) (p’s < 0.001) |
Nursing home residents | Intervention group = received the Canadian Red Cross Society’s Senior’s Fun and Fitness program. | Pulse = beats/min | ||||
Cognitively unimpaired | Three cognitive tests: | |||||
Male, 4; Female, 16 | 1. Set test = number of words correctly recalled; | Control group = no differences in pulse rate (between 74.1 to 74.7 beats/min), blood pressure (from 137/74 to 136/72 mmHg), and three cognitive tests (p’s > 0.05). | ||||
Intervention group (n = 10) | Control group = viewed a 15-min video of low-intensity exercise program | |||||
Mean age: 83.9 | 2. Word fluency test = number of words correctly recalled; | |||||
Control group (n = 10) | Between groups, intervention group = showed a better cognitive performance (i.e., improved recall ability in the Set test (40 words to 46 words) than the control group (43 words to 44 words) (p < 0.05)) | |||||
Mean age = 85.1 | Overall intervention compliance = no information | 3. Symbol digit test = number of corrected digit encoding | ||||
Means et al., 1996 [61] | Physical health | Pre-post test |
N = 65 | Duration, 6 weeks | Performance score (0 = poorest performance to 3 = best performance; total point = 36) and completion time (in seconds) on a functionally oriented obstacle course | Practice group = significantly decreased the completion time (440.9 to 351.6 s); increased in performance score (24.6 to 26.4) (p’s < 0.05) |
Community-dwelling; | Balance and mobility exercise protocol: | |||||
One or more falls within a year prior to the study | Active stretching, postural control, endurance walking, repetitive muscle coordination exercises | |||||
Non-practice group = significantly decreased the completion time (319.1 to 293.5 secs); increased in performance score (25.7 to 26.7) (p’s < 0.05) | ||||||
Gender: no specified | Self-reported falls = number of falls | |||||
Cognitive intervention sessions | Fall related injuries | Between groups = no significant differences in the completion time performance score (p > 0.05) | ||||
Intervention group (n = 31) | Practice group = received extra training on an obstacle course along with the exercise protocol | |||||
Mean age: 75 | Between groups = no significant difference in number of falls (p > 0.05) | |||||
Control group (n = 34) | ||||||
Mean age, 75 | Non-practice group = receive no training on an obstacle course but only the exercise protocol | Overall, all participants = decreased the completion time (378 to 321 secs); improved in mean performance scores (from 25.2 to 26.5 points) after the exercise protocols | ||||
Overall intervention compliance = no information | ||||||
Wolfson et al., 1996 [68] | Physical health | RCT |
N = 110 | Phase 1 | Loss of balance during sensory organization test (LOB) = number of times that participants received support from the experimenter | Balance group = significant improvements in LOB (3.6 to 1.4), FBOS (0.44 to 0.52 % of foot length), SST (12.2 to 16.6 s) (p’s < 0.001); no improvement in ISOK (8.0 to 8.1 Nm/kg) and UGV (1.14 to 1.18 m/s) (p’s > 0.05) |
Community-dwelling | 3-month balance and strength training were provided to the respective groups (45-min per week) | |||||
Healthy | ||||||
Male, 64; Female, 46 | ||||||
Balance group (n = 28) | Control group was encouraged to continue their usual activities | Functional Base of Support (FBOS) = % of foot length | Strength group = significant improvements in ISOK (6.5 to 8.0 Nm/kg) and LOB (3.7 to 2.1) (p’s < 0.001); no improvements in other measures: FBOS (0.38 to 0.39 % of foot length), and SST (9.1 to 10.0 secs), and UGV (1.08 to 1.17 m/s) (p’s > 0.05) | |||
Mean age, 78.9 | ||||||
Strength group (n = 28) | Phase 2 | Single Stance Time (SST) = seconds | ||||
Isokinetic strength (ISOK) = Nm/kg | ||||||
Mean age, 80.0 | 6-month low-intensity balance and strength maintenance programe (Tai Chi training with self-administered home practice) (1 hour per week) | Usual Gait Velocity (UGV) = m/s | Balance and strength group = significant improvements in LOB (3.6 to 1.9), FBOS (0.4 to 0.5 % of foot length), SST (5.4 to 15.1 secs), ISOK (6.8 to 8.0 Nm/kg) (p’s < 0.001); no significant improvement in UGV (1.12 to 1.09 m/s) (p’s > 0.05) | |||
Balance and strength group (n = 27) | ||||||
Mean age, 79.7 | ||||||
Control group (n = 27) | ||||||
Mean age, 80.6 | Overall intervention compliance = 72 % | Overall, no group differences (p’s > 0.10) | ||||
Mangione et al., 1999 [60] | Physical health | Pre-post test |
N = 39 | Duration, 10 weeks | Timed chair rise = second | High intensity group = significantly reduced the chair rise time (23.5 to 19.3 secs) and AIMS2 pain score (4.3 to 3.0); significantly increased in 6-min walk (488.0 to 540.6 m), aerobic capacity (11.0 to 13.3 min), and peak oxygen |
Exercise training = Stationary cycling; 1 hour each session; cycle 25 min; 3 times per week | 6-min walk test = m | |||||
Arthritis Impact Measurement Scale 2 (AIMS2) pain score | ||||||
High intensity group = stationary cycling at 70 % heart rate reserve | ||||||
Aerobic capacity time for graded exercise test = min | consumption (1454.1 to 1545.3 ml/min) (p’s < 0.01) | |||||
Low-intensity group = stationary cycling at 40 % heart rate reserve | ||||||
Low-intensity group = significantly reduced the chair rise time (23.1 to 19.0 secs) and AIMS2 pain score (3.6 to 3.1); significantly increased in 6-min walk (491.1 to 526.9 m), aerobic capacity time (11.1 to 13.0 min), and peak oxygen consumption (1710.2 to 1807.3 ml/min) (p’s < 0.01) | ||||||
Peak oxygen consumption = ml/min | ||||||
Overall intervention compliance = no information | ||||||
Suffered from knee osteoarthritis | ||||||
Community-dwelling | ||||||
Male, 13; Female, 26 | ||||||
High intensity cycling group (n = 19) mean age = 71.1 | ||||||
Low-intensity cycling group (n = 20) | ||||||
Mean age = 71.0 | ||||||
Study | Domain | Design | Sample | Intervention | Key outcomes | Results |
Brown et al., 2000 [55] | Physical health | RCT |
N = 87 | Duration, 3 months | Physical Performance Test (PPT) score | EXER group = significant improvements on the PPT score (29 to 31 points), strength measures (e.g., isometric knee extension: 62 to 65 ft/lb), ranged of motion (e.g., shoulder flexion: 160 to 165 mm), balance measures (e.g., one-limb stand: 4.1 to 7.6 s), and coordination and response time (358 to 377) (p’s < 0.05); no significant improvements in gait measures (p > 0.05) |
Community-dwelling | Supervised exercise group = low-intensity supervised exercise program (22 exercises; 3 times per week) targeting all muscle groups | Strength measures = ft/lb | ||||
<32 points on Physical Performance Test (PPT) | Range of motion = mm | |||||
Balance measures: | ||||||
Male, 20; Female, 28 | Obstacle course = second; functional reach = inch; Romberg = second; one-limb stand = second; balance beam = second) | |||||
Supervised exercise group (EXER) (n = 48) | Home-based flexibility activity group = some of the exercises done in the other group and were not supervised. | |||||
HOME group = no significant improvements on PPT score (29 to 29 points), strength measures (e.g., Isometric knee extension: 56 to 54 ft/lb), balance measures (e.g., one-limb stand, 4.9 to 5.2 secs) and gait measures (p’s > 0.05); significant improvements in range of motion (e.g., should flexion, 159 to 161 mm), balance, gait, coordination/response time (351 to 417 msecs) (p’s < 0.05) | ||||||
Gait measures : gait velocity = m/min; stride length = m ; stance time = second; swing = % of gait cycle; stance = % of gait cycle; double stance = % | ||||||
Mean age, 83 | Overall intervention compliance = no information | |||||
Home-based flexibility activity group (HOME) (n = 39) | ||||||
Coordination/response = msec | ||||||
Mena age, 83 | ||||||
DeVito et al., 2000 [57] | Physical health | Pre-post test |
N = 105 | Duration, 8–10 months | Mobility measures score | Intervention group = significant improvements in all outcomes (e.g. Balance score: 9.6 to 12.8) (p’s < 0.001) |
Had a hospital admission lasting 2 days or more or had been on bed rest for 2 days or more within the past 1 month | Intervention group = 24 sessions (45 min) of 3 sets of low-intensity standard exercise modalities (3 times a week) targeting on flexibility, postural stability, balance and gait (e.g., extend leg up then back down, raise up and down on toes then heels, march in place etc.); continue performing exercise until 1 year after the baseline assessment; Individualization of the program according to participant’s ability and progress | Gait score | ||||
Balance score | Control group = significant improvements in all outcomes (e.g., Balance score: 9.8 to 10.4) (p’s < 0.001) | |||||
Muscle strength score | ||||||
Between groups = intervention group has significant greater samples in improving in gait, balance and mobility measures (p’s < 0.001). e.g., 35.1 % of intervention group increased in walking ability while 15.9 % of control groups increased in walking ability (p < 0.001) | ||||||
Male, 47; Female, 58 | ||||||
Intervention group (n = 60) | ||||||
Mean age, 80 | ||||||
Control group (n = 45) | ||||||
Mean age, 81 | ||||||
Control group = usual activities | ||||||
Overall intervention compliance = 91 % | ||||||
Schnelle et al., 2003 [66] | Physical health | RCT |
N = 190 | Duration, 8 months | Medical conditions (dermatological, genitourinary, gastrointestinal, respiratory, endocrine, neurological and cardiovascular systems, falls, and pain, psychiatric and nutritional disturbances) were extracted | Between groups = intervention group has significant smaller number of falls than the control group (p’ < 0.05); no difference on other medical conditions and cost of treatment (p’s > 0.05) |
Living in nursing home | Intervention group = engaged into the low-intensity functional oriented exercise program: Functional Incidental Training (FIT) (5 days a week; every 2 h between 0800 to 1600) | |||||
Male, 28; Female, 162 | ||||||
Intervention group (n = 92) | ||||||
Mean age, 87.3 | Cost of treatment | |||||
Control group (n = 98) | ||||||
Mean age, 88.6 | Control group = received usual care from NH staff; no change in their physical activity or other measures. | |||||
Overall intervention compliance = 91 % | ||||||
Morgan et al., 2004 [63] | Physical health | RCT |
N = 229 | Duration, 8 weeks | Gait and balance (Tinetti’s gait and balance assessment measures) | Exercise group = 28.6 % participants fell; risk of falling decreased with low baseline physical function (p < 0.001); increased fall risk with high physical function (p < 0.001) |
Had a hospital admission or bed rest for 2 days or more within the previous month | Exercise group = perform chair-sitting exercise and standing balance exercises; 3 times per week. | |||||
Control group = 30.9 % participants fell | ||||||
Self-reported functional status (SF-36) = range, 0-100 | ||||||
Control group = continue their usual activities. | Number of fall for 1 year after the assessment | Overall, 29.7 % of the participants reported a fall during study period | ||||
Overall intervention compliance = 70 % | ||||||
Male, 67; Female, 162 | ||||||
Exercise group (n = 119) | ||||||
Mean age, 81.0 | ||||||
Control group (n = 110) | ||||||
Mean age, 80.1 |