Review article (meta-analysis)
Physical Exercise Interventions for Improving Performance-Based Measures of Physical Function in Community-Dwelling, Frail Older Adults: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.apmr.2013.11.007Get rights and content

Abstract

Objective

To conduct a systematic review to determine the efficacy of exercise-based interventions on improving performance-based measures of physical function and markers of physical frailty in community-dwelling, frail older people.

Data Sources

Comprehensive bibliographic searches in MEDLINE, the Cochrane Library, PEDro, and CINAHL databases were conducted (April 2013).

Study Selection

Randomized controlled trials of community-dwelling older adults, defined as frail according to physical function and physical difficulties in activities of daily living (ADL). Included trials had to compare an exercise intervention with a control or another exercise intervention, and assess performance-based measures of physical function such as mobility and gait, or disability in ADL.

Data Extraction

Two review authors independently screened the search results and performed data extraction and risk of bias assessment. Nineteen trials were included, 12 of them comparing exercise with an inactive control. Most exercise programs were multicomponent.

Data Synthesis

Meta-analysis was performed for the comparison of exercise versus control with the inverse variance method under the random-effects models. When compared with control interventions, exercise was shown to improve normal gait speed (mean difference [MD]=.07m/s; 95% confidence interval [CI], .04–.09), fast gait speed (MD=.08m/s; 95% CI, .02–.14), and the Short Physical Performance Battery (MD=2.18; 95% CI, 1.56–2.80). Results are inconclusive for endurance outcomes, and no consistent effect was observed on balance and the ADL functional mobility. The evidence comparing different modalities of exercise is scarce and heterogeneous.

Conclusions

Exercise has some benefits in frail older people, although uncertainty still exists with regard to which exercise characteristics (type, frequency, duration) are most effective.

Section snippets

Methods

We included randomized controlled trials (RCTs) evaluating the effect of physical exercise programs with or without other components on functional performance-based measures of physical function among community-dwelling, frail older adults. Inclusion criteria were as follows: participants should be (1) 65 years and older; (2) living in the community; and (3) defined as frail according to standardized criteria (eg, Fried's), or considered frail according to reduced physical function measured

Results

A total of 38 citations providing data from 19 trials were included in this systematic review.27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63 The flow chart of references and the causes of exclusion are presented in figure 1. We faced some challenges in assessing inclusion criteria: we included trials whose participants had moderate dependence in mobility, but we excluded trials on participants

Discussion

This systematic review has identified the available evidence on the effect of exercise in frail elderly people. When compared with control interventions, exercise has shown to improve gait speed and the SPPB in the frail elderly.

Results are inconclusive for endurance outcomes, and no consistent effect was observed on balance and functional status. The evidence comparing different modalities of exercise is scarce, and it is not possible to pinpoint which exercise characteristics (type,

Conclusions

Exercise has some benefits in frail older people, although uncertainty still exists with regard to which exercise characteristics (type, frequency, intensity, duration, setting, combinations) are most effective. When compared with control interventions, exercise has shown to improve gait speed and the SPPB in the frail elderly. However, results are inconclusive for endurance outcomes, and no consistent effect was observed on balance and functional mobility.

Some aspects to be taken into account

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Acknowledgments

We thank Àlex Domingo (Institute on Aging, Barcelona) for developing and conducting the bibliographic search strategy, and Dr. Rydwik, MD, PhD, for providing additional information on her trial. Marta Roqué-Fíguls is a doctorate candidate at the Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, Spain.

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