Background
Methods
Search strategy
Eligibility criteria
Study selection
Methodological quality assessment of included trials
Data extraction
Statistical analysis
Results
Literature search
Study characteristics
Study | Study population /Inclusion criteria | N (♀women/♂men) | Age mean (SD) | Gait speed Control Group | Gait speed Intervention Group | |||
---|---|---|---|---|---|---|---|---|
(m/s) Mean (SD) Baseline Posttest | (m/s) Mean (SD) Baseline Posttest | |||||||
1
| Arai (2007) [37] | Community dwelling older adults > 65 years who were ambulatory with or without assisting device (Japan) | 171 (?♀/?♂) | 74.1 | 1.24 (0.21) | 1.26 (0.20) | 1.28 (0.24) | 1.30 (0.22) |
2
| Baker (2007) [40] | Community dwelling older adults ≥ 60 years, residents in the retirement villages (Australia) | 38 (24♀/ 14♂) | 76.6 (6.1) | 1.19 (0.23) | 1.16 (0.25) | 1.23 (0.28) | 1.12 (0.23) |
3
| Barnett (2003) [39] | Community dwelling with one or more risk factors for falls (Australia) | 163 (109♀/ 54♂) | 74.9 (5.5) | 0.97 (0.35) | 0.98 (0.38) | 0.95 (0.30) | 0.98 (0.30) |
4
| Community dwelling older adults ≥ 65 years, MMSE* score ≥ 24/30, complete a Timed Up and Go test ≥ 13.5 s, and/or have 2 or more falls in the past year or 1 fall with injury (Canada) | 23 (11♀/ 12♂) | 80.0 (5.8) | 0.90 (0.22) | 0.91 (0.21) | 0.88 (0.20) | 0.95 (0.22) | |
5
| Cress (1999) [34] | Community dwelling older adults ≥70 years (USA) | 56 (♀/♂) | 75.8 (4.4) | 1.37 (0.30) | 1.36 (0.16) | 1.46 (0.20) | 1.52 (0.13) |
6
| Doi (2013) [41] | Community dwelling older adults ≥ 65 years with Mild Cognitive Impairment (MMSE score between 24 and 30 and memory impairment (Japan) | 50 (23♀ / 27♂) | 76.1 (7.2) | 1.10 (0.20) | 1.26 (0.21) | 1.10 (0.32) | 1.38 (0.32) |
7
| Fiatarone (1994) [29] | Nursing home residents (long term care) >70 years (USA) | 100 (63♀/37♂) | 87.1 (0.6) | 0.47 (0.20) | 0.45 (0.10) | 0.51 (0.20) | 0.55 (0.10) |
8
| Freiberger (2007) [30] | Community dwelling older adults ≥70 years (Germany) | 217 (97♀/ 45♂) | 75.9 (4.0) | 1.30 (0.30) | 1.30 (0.30) | 1)1.30 (0.30) | 1)1.30 (0.20) |
2)1.40 (0.30) | 2)1.40 (0.20) | |||||||
9
| Freiberger (2012) [32] | Community dwelling older adults ≥70 years, having fallen in the past 6 months or with fear of falling (Germany) | 280 (122♀/ 158♂) | 76.1 (4.1) | 0.95 (0.27) | 0.97 (0.18) | 1)0.95 (0.22) | 1)0.92 (0.22) |
2)0.98 (0.18) | 2)1.00 (0.17) | |||||||
3)0.98 (0.20) | 3)0.95 (0.20) | |||||||
10
| Gine-Garriga (2010) [38] | Physically frail home-dwelling persons >10 s. on rapid gait test / not able to make 5 chair stands with hands folded or self-reported exhaustion (Spain) | 51 (31♀/ 20♀) | 84.0 (2.0) | 0.82 (0.04) | 0.80 (0.04) | 0.82 (0.04) | 0.94 (0.04) |
11
| Granacher (2012) [45] | Community dwelling older adults between 63–82 years (Germany) | 28 (17♀/ 11♀) | 70.8 (5.0) | 1.42 (0.14) | 1.42 (0.14) | 1.34 (0.20) | 1.49 (0.26) |
12
| Granacher (2013) [49] | Community dwelling older adults between 63–80 years without prior experience with core stability training (Germany) | 32 (17♀/ 15♀) | 70.5 (4.3) | 1.42 (0.15) | 1.42 (0.19) | 1.41 (0.14) | 1.53 (0.14) |
13
| Halvarsson (2011) [47] | Healthy community dwelling older adults > 65 with fear of falling and/or an experience of a fall during the previous 12 months, ability to walk unaided indoors and a MMSE score ≥24. (Sweden) | 58 (42♀/17♂) | 76 | 1.09 (0.22) | 1.10 (0.23) | 1.11 (0.24) | 1.20 (0.17) |
14
| Hartmann (2009) [43] | Community dwelling older adults > 65 (Switzerland) | 42 (28♀/ 14♂) | 76.0 (5.8) | 1.33 (0.19) | 1.27 (0.14) | 1.34 (0.19) | 1.41 (0.19) |
15
| Kerrigan (2003) [17] | Healthy community dwelling older adults ≥ 65 (USA) | 96 (66♀/ 30♂) | ? | 1.19 (0.17) | 1.23 (0.18) | 1.19 (0.18) | 1.23 (0.18) |
16
| Kim (2011) [42] | Community dwelling elderly women with multiple symptoms of geriatric syndrome ≥ 70 (Japan) | 61♀ | 78.6 (4.2) | 1.20 (0.20) | 1.10 (0.30) | 1.10 (0.30) | 1.10 (0.30) |
17
| Lazowski (1999) [28] | Residents of long-term care institutions with the ability to stand with minimal assistance, follow simple instructions/ demonstrations (Canada) | 68 (59♀/ 9♂) | 80.0 (0.9) | 0.57 (0.27) | 0.61 (0.31) | 0.69 (0.28) | 0.73 (0.33) |
18
| Community-dwelling women 60-years and older | 160♀ | 71.1 (5.2) | 1.15 (0.19) | 1.12 (0.18) | 1.12 (0.19) | 1.18 (0.18) | |
19
| Liu-Ambrose (2004) [31] | Elderly women with osteoporosis or osteopenia (Canada) | 98♀ | 79.0 (3.0) | 0.91 (0.20) | 1.00 (0.19) | 1)1.02 (0.25) | 1)1.11 (0.22) |
2)1.02 (0.19) | 2)1.09 (0.19) | |||||||
20
| Lustosa (2011) [36] | Thirty-two women, over 65 years old, community-dwelling, without restriction regarding race and/or social class, classified as pre-frail according to the criteria established by Fried et al. were selected (Brazil) | 32♀ | 72.0 (3.8) | 1.22 (0.22) | 1.23 (0.16) | 1.24 (0.14) | 1.38 (0.16) |
21
| Persch (2009) [35] | Elderly women (aged 60 years and over) attending local community meetings in the vicinity of the University (Brazil) | 27♀ | 61.4 (5.5) | 1.09 (0.11) | 1.08 (0.14) | 1.10 (0.03) | 1.23 (0.07) |
22
| Tiedemann (2013) [50] | Community-dwelling older adults (Australia) | 54 (43♀/ 11♂) | 67.5 (6.6) | 1.60 (0.24) | 1.43 (0.21) | 1.54 (0.23) | 1.67 (0.17) |
23
| Community-dwelling older adults (USA) | 42 (33♀/ 19♂) | 71.5 (1.2) | 1.22 (0.14) | 1.24 (0.11) | 1.24 (0.14) | 1.28 (0.06) | |
24
| Trombetti (2010) [44] | Community-dwelling individuals older than 65 years, who are at increased risk of falling (Switzerland) | 134 (129♀/ 5♂) | 75.5 (7.0) | 1.02 (0.19) | 1.04 (0.13) | 1.04 (0.19) | 1.10 (0.13) |
25
| Watt (2011) [18] | Healthy older adults with aged 65 years and older (USA) | 82 | 72.6 (6.0) | 1.22 (0.21) | 1.22 (0.19) | 1.31 (0.25) | 1.33 (0.24) |
26
| Frail elderly with (1) a low Instrumental Activities of Daily Living score (<3/5); (2) a major orthopedic diagnosis in the lower back, pelvis, or lower extremities since the age of 50 years; or (3) a performance on a Mini Mental Status Examination of less than 24 out of 30 (USA) | 100 | 77.0 (8.0) | 1.10 (0.20) | 1.10 (0.20) | 1.15 (0.2) | 1.20 (0.20) | |
74 analyzed (40♀/ 34♂) | ||||||||
27
| Wolf (2006) [48] | Transitionally frail older adults from independent living facilities with 4 frail and no more than 1 vigorous attributes according to the criteria of Speechly & Tinetti (USA) | 212 (192♀/ 20♂) | 80.9 | 0.94 (0.49) | 0.99 (0.45) | 1.01 (0.48) | 1.08 (0.44) |
28
|
Yang (2011)
| Older people (>65 years) who reported concerns about their balance but remained community ambulant (Australia) | 165 (73♀/ 92♂) | 80.6 (6.2) | 1.09 (0.22) | 1.04 (0.23) | 1.02 (0.26) | 1.02 (0.22) |
PROGRESSIVE RESISTANCE TRAINING
| |||||||||
---|---|---|---|---|---|---|---|---|---|
Study Ascending effect | Intervention | Duration and frequency | Total doses (minutes) | Intensity | Baseline gait speed (mean (SD)) | Gait speed test | Exercise compliance | Mean age | Pedro score |
Fiatarone (1994) [29] | Progressive resistance exercise training of hip and knee extensors | 10 weeks, 3x p/w; 45 min. | 1350 | 80 % of 1 RM | 0.51 (0.20) | Stopwatch: 6.1-m course | 97 % | 87 | 7 |
Liu-Ambrose (2004) [31] | Progressive high- intensity resistance training initially set at 50–60 % of 1RM (two sets of 10–15 repetitions) progressing to 75-85 % of 1 RM (two sets of 6–8 repetitions) | 13 weeks, 2x p/w 50 min. | 1300 | Progressing from 50-60 % to 75–85 % of 1RM | 1.02 (0.25) | Stopwatch: 5-m | 85,4 % interv. | 79 | 5 |
78.8 % control | |||||||||
Lustosa (2011) [36] | Supervised lower limbs exercises with open chain ankle weights exercises and closed chain body weight exercises | 10 weeks, 3x p/w, 60 min. | 1800 | 50-70 % of 1 RM | 1.24 (0.14) | Stopwatch: 10-m (accelerated) | - | 72 | 7 |
Persch (2009) [35] | Supervised progressive lower limb strength training | 12 weeks, 3x p/w, (estimated at 50 min.) | +/−1800 | 10-12 maximal reps. | 1.23 (0.07) | 6-camera motion analysis system (Vicon) | 93 % | 61 | 6 |
Cress (1999) [34] | Supervised combined endurance and strength training | 6 months, 3x p/w for 60 min. | 4860 | 75-80 % intensity (1 RM and HRR) | 1.46 (0.20) | Stopwatch: 20-m course | 80.5 % | 76 | 5 |
PROGRESSIVE RESISTANCE + BALANCE TRAINING
| |||||||||
Freiberger (2012) [32] | 1)(SB)Strength and balance group: Progressive upper and lower body strength, balance -, and motor coordination training | 16 weeks, 2x p/w; 60 min. | 1920 | Progressive exertion according BORG scale (not specified) | 0.95 (0.22) | Stopwatch: 8-m course (accelerated) | 83 % attended ≥ 24 of 32 sessions | 76 | 8 |
Yang (2011)
| Personalized home balance and strength exercise program (Based on Otago Exercise Program) | 6 months, 5x p/w for +/− 20 min. and daily graduated walking program | 2700 | Progressive adjustments at 1, 4 and 8 weeks after the baseline | 1.02 (0.26) | Stopwatch: 6-m (accelerated) | 44.1 % 5x p/w | 71 | 7 |
39 % 3-4x p/w | |||||||||
13.6 % <2x p/w | |||||||||
Arai (2007) [37] | Supervised progressive resistance training and balance training according to ACSM guidelines | 3 months, 2x p/w for 90 min. | 2430 | 65-75 % of 1 RM, 10–15 reps. | 1.28 (0.24) | Stopwatch: 10-m (accelerated) | - | 74 | 5 |
Gine-Garriga (2010) [38] | Overload functional circuit training focused at functional balance and lower body strength | 12 weeks, 2x p/w; 45 min. | 1080 | Strength training at perceived exertion of 12–14 on the BORG scale increasing from 6–15 reps. Increasing difficulty in balance exercise | 0.82 (0.04) | Stopwatch: 8-m couse (accelerated) | 90 % interv. | 84 | 6 |
76 % control | |||||||||
PROGRESSIVE RESISTANCE + BALANCE + ENDURANCE TRAINING
| |||||||||
Baker (2007) [40] | Supervised exercise: high-intensity progressive resistance training 3 days per week, moderate-intensity aerobic training 2 days per week, and progressive balance training 1 day per week | 10 weeks, 3 to 4 h per week divided over 3 days | 5400-7200 | 80 % of 1RM. Aerobic training: rating of perceived exertion 11 to 14 (20) on the BORG scale | 1.23 (0.28) | Ultrasonic transmitter/ receiver over 2-m | 90 % (excluding dropouts) | 77 | 7 |
Barnett (2003) [39] | Supervised exercise consisting of balance, coordination, endurance and strength training + home exercise program based on class content | 4 periods over 1 year 1x p/w; 60 min. (37 lessons) | 2220 | Complexity, speed and resistance were steadily increased over de 4 periods | 0.95 (0.30) | Stopwatch: 6-m course | 33.7 % attended ≥ 30 of 37 sessions | 75 | 8 |
Freiberger (2012) [32] | 2)(FG)Fitness Group; Strength-, balance -and endurance training | 16 weeks, 2x p/w; 60 min. | 1920 | Progressive in duration and exertion according BORG scale (not specified) | 0.98 (0.18) | Stopwatch: 8-m course (accelerated) | 83 % attended ≥ 24 of 32 sessions | 76 | 8 |
Freiberger (2007) [30] | Fitness intervention: group and home-based strength, flexibility-, balance and motor coordination-, and endurance training | 16 weeks, 2x p/w; 60 min. | 1920 | Not described | 1.40 (0.30) | Stopwatch: 8-m (accelerated) | 84 % | 76 | 7 |
Doi (2013) [41] | Supervised multicomponent exercise including aerobic exercise, balance-, strength- and gait training | 6 months, 2x p/w for 90 min. | 4860 | Aerobic exercise and gait-training at 60 % max HR. | 1.46 (0.20) | Tri-axial accelerometer: 5-m (accelerated) | 86.9 % | 76 | 5 |
MULTIMODAL TRAINING
| |||||||||
Freiberger (2012) [32] | 3)(MG)Multifaceted group: Strength and balance, cognition training and fall risk education | 16 weeks, 2x p/w; 60 min. | 1920 | Progressive exertion according BORG scale (not specified) | 0.98 (0.20) | Stopwatch: 8-m course (accelerated) | 83 % attended ≥ 24 of 32 sessions | 76 | 8 |
Kim (2011) [42] | Weight bearing exercise, chair exercise, resistance band exercise, ball exercise, walking ability training | 3 months, 2x p/w 60 min. | 1620 | Not described | 1.10 (0.30) | Stopwatch: ? | 77,4 % (≥15 of 24 sessions) | 79 | 7 |
Freiberger (2007) [30] | Supervised Psychomotor intervention: strength-, balance-, motor coordination-, competence-, and perceptual training | 16 weeks, 2x p/w; 60 min. | 1920 | Not described | 1.40 (0.30) | Stopwatch: 8-m (accelerated) | 84 % | 76 | 7 |
Lazowski (1999) [28] | Supervised multicomponent; strength, balance, flexibility, mobility and function | 4 months, 3x p/w 45 min. | 2430 | Self-paced progressive resistance | 0.69 (0.28) | Stopwatch: 7-m (accelerated) | 85-87 % interv. | 80 | 6 |
79 % control | |||||||||
Hartmann (2009) [43] | Aerobic exercises, progressive resistance strength training and stretching exercises + additional foot gymnastic exercises at the end of the training session and a 10-min foot gymnastics home-program daily | 12 weeks, 2x p/w supervised 50 min. + 10 min. daily at home | 1200+ 840 = 2040 | Resistance training 2–3 sets of 12 reps. at an intensity of ‘hard; to ‘very hard’(16–18) on the BORG scale | 1.33 (0.19) | DynaPort1MiniMod; tri-axial accelerometer system over 24-m | All subjects completed 24 sessions within 16 weeks | 76 | 6 |
DANCE/ RHYTHMIC COMPONENT
| |||||||||
Trombetti (2010) [44] | Supervised progressive multi-task exercises, rhythmic walking | 6 months, 1x p/w for 60 min. | 1620 | Progressing difficulty of exercises | 1.04 (0.19) | GAITRite:10-m long electronic gait mat | 78 % | 76 | 6 |
Granacher (2012) [45] | Salsa dance training with a dance partner | 8 weeks, 2x p/w; 60 min. | 960 | Increasing music tempo: 50- > 70 BPM | 1.34 (0.20) | GAITRite: 10-m long electronic gait mat | 92,5 % | 71 | 6 |
Liu-Ambrose (2004) [31] | Agility training; ball games, relay races, dance movements, and obstacle courses | 13 weeks, 2x p/w 50 min. | 1300 | Not described | 1.02 (0.19) | Stopwatch: 5-m | 85,4 % interv. 78.8 % control | 79 | 5 |
STRETCHING
| |||||||||
Kerrigan (2003) [17] | Hip-stretching exercise at home | 10 weeks, 2x p/d; 5 min. | 700 | 4 sets of 30 s. | 1.19 (0.18) | 6-camera motion analysis system (Vicon) | 94 % | ? | 7 |
Watt (2011) [18] | Daily hip flexor stretching program, which was supervised twice weekly by 2a rehabilitation clinician | 10 weeks, 2x p/d 4 min. home program, 2x p/w supervised | 560 | 2 sets of 60 s. | 1.31 (0.25) | 10-camera motion analysis system (Vicon 624) | 91 % | 73 | 5 |
Daily hip flexor stretching program, which was supervised twice weekly by a rehabilitation clinician | 10 weeks, 2x p/d 4 min home program, 2x p/w supervised | 560 | 2 sets of 60 s. | 1.15 (0.2) | 10-camera motion analysis system (Vicon 624) | 91 % | 77 | 5 | |
BALANCE
| |||||||||
Wolf (2006) [48] | Tai Chi training supplemented with home- based exercise | 48 weeks, 2x p/w; 60–90 min. | 5760-8640 | Progressive duration of 60–90 min | 1.01 (0.48) | Stopwatch: 10-m (accelerated) | - | 81 | 7 |
Halvarsson (2011) [47] | Individually adjusted, progressive and specific balance group training | 3 months, 3x p/w; 60 min. | 2430 | Progressing demands on the postural control system (5 levels) | 1.11 (0.24) | GAITRite: 8-m long electronic gait mat | 87 % | 76 | 7 |
REMAINING
| |||||||||
Granacher (2013) [49] | Core stability training at moderate intensity | 9 weeks, 2x p/w; 60 min | 1080 min | Progressively, individually increased (lever lengths, ROM, movement velocity, level of stability) | 1.41 (0.14) | 10-m-long electronic gait mat, GAITRite | 92 % | 71 | 6 |
Tiedeman (2013) [50] | Iyengar-style yoga | 12 weeks, 2x p/w; 60 min + 2x p/w 10–20 min at home | 1800 | Gradually increasing difficulty (time, balance) of postures | 1.54 (0.23) | Stopwatch: 4-m (accelerated) from SPPB | 83 % | 68 | 8 |
The meta-analyses
The effect of progressive resistance training on preferred gait speed (Fig. 2A)
The effect of progressive resistance-, and balance training on preferred gait speed (Fig. 2B)
The effect of progressive resistance-, balance-, and endurance training on preferred gait speed (Fig. 2C)
The effect of multimodal exercise other than a combination of progressive resistance-, balance-, and endurance training on preferred gait speed (Fig. 2D)
The effect of interventions with a rhythmic component on preferred gait speed (Fig. 2E)
The effect of stretching on preferred gait speed (Fig. 2F)
Exercise Intervention | Interventions | Meta-effect | Homogeneous | Influential study | Unbiased |
---|---|---|---|---|---|
Progressive resistance training | 5 | YES | YES | NO | YES |
Progressive resistance training + Balance | 4 | NO | NO | NO | YES |
Progressive resistance training + Balance + Endurance | 5 | YES | YES | YES | YES |
Multimodal | 5 | NO | YES | NO | YES |
Rythmic | 3 | YES | YES | NO | YES |
Stretching | 3 | NO | YES | YES | NO |
Balance | 2 | - | - | - | - |
Other (yoga/Core stability) | 2 | - | - | - | - |
Sub-analyses
Studies not included in the meta-analyses
Long-term follow up analyses
Study | Baseline | Post-intervention | +3-months follow up | +6-month follow up | +12- months follow up | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N | m/s (SD) | N | m/s (SD) | N | m/s (SD) | N | m/s (SD) | N | m/s (SD) | ||
Halvarsson (2013) [53] | Intervention | 38 | 1.11 (0.23) | 34 | 1.19 (0.17) | - | - | 32 | 1.16 (0.19) | 30 | 1.15 (0.24) |
Control | 21 | 1.09 (0.22) | 21 | 1.10 (0.23) | - | - | 20 | 1.08 (0.22) | 18 | 1.02 (0.28) | |
Kim (2011) [42] | Intervention | 31 | 1.10 (0.30) | 30 | 1.10 (0.20) | 30 | 1.20 (0.20) | - | - | - | - |
Control | 30 | 1.20 (0.20) | 29 | 1.10 (0.20) | 29 | 1.10 (0.30) | - | - | - | - | |
Gine-Garriga 2013 | Intervention | 26 | 0.82 (0.19) | 22 | 0.94 (0.19) | - | - | 18 | 0.88 (0.19) | - | - |
Control | 25 | 0.82 (0.17) | 19 | 0.80 (0.17) | - | - | 7 | 0.81 (0.17) | - | - | |
Freiberger (2012) [32] | Intervention SB | 63 | 0.95 (0.22) | 57 | 0.92 (0.22) | - | - | 53 | 0.93 (0.22) | 49 | 0.98 (0.20) |
FG | 64 | 0.98 (0.18) | 57 | 1.00 (0.17) | - | - | 54 | 0.97 (0.19) | 48 | 1.03 (0.16) | |
MG | 72 | 0.98 (0.20) | 69 | 0.95 (0.20) | - | - | 69 | 0.93 (0.20) | 57 | 0.93 (0.19) | |
Control | 78 | 0.95 (0.27) | 70 | 0.97 (0.18) | - | - | 64 | 0.93 (0.20) | 51 | 0.95 (0.24) |