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The effects of exercise on strength and physical performance in frail older people: a systematic review

Published online by Cambridge University Press:  03 July 2012

Katharine CM Nash
Katharine CM Nash*
Affiliation:
Royal United Hospital NHS Trust, Bath, UK
*
Address for correspondence: Mrs Katharine CM Nash, Physiotherapy Department, Royal United Hospital NHS Trust, Combe Park, Bath BA1 3NG. Email: [email protected]
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Summary

The proportion of older people becoming frail will increase with the expanding older population. Apart from poor health, frailty is associated with loss of strength and functional dependency. Building on previous work in this area, this review investigates the effectiveness, sustainability and adverse effects of exercise interventions on muscle strength and physical performance in frail older people. Randomized controlled trials reporting physical outcomes in frail older people were identified from seven electronic databases. Thirteen trials involving 1652 participants met the inclusion criteria. There was wide heterogeneity in degree of frailty, types of intervention, outcome measures and results. However, evidence from this review suggests that exercise and some physical activity programmes, particularly moderate intensity and multi-component programmes, are safe and can improve strength and function in the majority of frail older people except highly frail individuals with multiple co-morbidities. There was limited evidence on transferability of improvements into everyday life, and sustainability could not be determined.

Keywords

frailtyexercisephysical trainingrandomized controlled trialssystematic review
Type
Intermediate care and rehabilitation
Information
Reviews in Clinical Gerontology , Volume 22 , Issue 4 , November 2012 , pp. 274 - 285
Copyright
Copyright © Cambridge University Press 2012

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References

1Fried, LP, Ferrucci, L, Darer, J, Williamson, J, Anderson, G.Untangling the concepts of disability, frailty and comorbidity: implications for improved targeting and care. J Gerontol A Bio Sci Med Sci 2004; 59: M255–63.CrossRefGoogle ScholarPubMed
2Ferrucci, L, Guralnik, JM, Studenski, S, Fried, LP, Cutler, GB, Walston, JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625–34.CrossRefGoogle ScholarPubMed
3Rockwood, K.Frailty and its definitions: a worthy challenge. J Am Geriatr Soc 2005; 53: 1069–70.CrossRefGoogle ScholarPubMed
4Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence of a phenotype. J Gerontol A Bio Sci Med Sci 2001; 56: M146–56.CrossRefGoogle Scholar
5Rockwood, K, Mitnitski, A. Frailty in relation to the accumulation of deficits. J Gerontol: Med Sci 2007; 62: 722–27.CrossRefGoogle Scholar
6Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JM, Boirie, Y, Cederholm, T, Landi, F, Martin, FC, Michel, JP, Rolland, Y, Schneider, SM, Topinková, E, Vandewoude, M, Zamboni, M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2010; 39: 412–23.CrossRefGoogle Scholar
7Chin A Paw, MJ, van Uffelen, JG, Riphagen, I, van Mechelen, W. The functional effects of physical training in frail older people. Sports Med 2008; 38: 781–93.CrossRefGoogle ScholarPubMed
8Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gøtzsche, PC, Ioannidis, JP, Clarke, M, Devereaux, PJ, Kleijnen, J, Moher, D. The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.CrossRefGoogle ScholarPubMed
9Higgins, JP, Green, S (eds). Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2, 2009. Available at: http://www.cochrane-handbook.org (accessed 1 November 2010).Google Scholar
10PEDro scale. Available at: http://www.pedro.org.au/english/downloads/pedro-scale (accessed 20 October 2010).Google Scholar
11Rydwik, E, Lammes, E, Frandlin, K, Akner, G. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled trial. Aging Clin Exp Res 2008; 20: 159–70.CrossRefGoogle Scholar
12Rydwik, E, Gustafsson, T, Frandin, K, Akner, G. Effects of physical training on aerobic capacity in frail elderly people (75+ years). Aging Clin Exp Res 2010; 22: 85–94.CrossRefGoogle ScholarPubMed
13Venturelli, M, Lanza, M, Muit, E, Schena, F. Positive effects of physical training in activity of daily living-dependent older adults. Exp Aging Res 2010; 36: 190–205.CrossRefGoogle ScholarPubMed
14Maggioni, MA, Cè, E, Rampichini, S, Ferrario, M, Giordano, G, Veicsteinas, A, Merati, G. Electrical stimulation versus kinesitherapy in improving functional fitness in older women: a randomized controlled trial. Arch Gerontol Geriatr 2010; 50: e19–25.CrossRefGoogle ScholarPubMed
15Holmerová, I, Machácová, K, Vanková, H, Veleta, P, Jurasková, B, Hrnciariková, D, Volicer, L, Andel, R. Effect of the Exercise Dance for Seniors (EXDASE) Program on lower-body functioning among institutionalized older adults. J Aging Health 2010; 22: 106–19.CrossRefGoogle ScholarPubMed
16Chandler, JM, Duncan, PM, Kochersberger, G, Studenski, S. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Physical Med Rehabil 1998; 79: 24–30.CrossRefGoogle ScholarPubMed
17Rosendahl, E, Lindelöf, N, Littbrand, H, Yifter-Lindgren, E, Lundin-Olsson, L, Håglin, L, Gustafson, Y, Nyberg, L. High-intensity functional exercise program and protein-enriched supplement for older persons dependent in activities of daily living: a randomized controlled trial. Australian Physiother Assoc 2006; 52: 105–13.CrossRefGoogle Scholar
18Sato, D, Kaneda, K, Wakabayashi, H, Nomura, T. The water exercise improves health-related quality of life of frail elderly people at day service facility. Qual Life Res 2007; 16: 1577–85.CrossRefGoogle ScholarPubMed
19Kerse, N, Peri, K, Robinson, E, Wilkinson, T, von Randow, M, Kiata, L, Parsons, J, Latham, N, Parsons, M, Willingale, J, Brown, P, Arroll, B. Does a functionally activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomized controlled trial. BMJ 2008; 337: a1445.CrossRefGoogle Scholar
20Vestergaard, S, Kronborg, C, Pugaard, L. Home-based video exercise intervention for community-dwelling older women: a randomized controlled trial. Aging Clin Exp Res 2008; 20: 479–86.CrossRefGoogle ScholarPubMed
21Dechamps, A, Diolez, P, Thiaudière, E, Tulon, A, Onifade, C, Vuong, T, Helmer, C, Bourdel-Marchasson, I. Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons. Arch Intern Med 2010; 170: 162–69.CrossRefGoogle ScholarPubMed
22McMurdo, ME, Johnstone, R. A randomized controlled trial of a home exercise programme for elderly people with poor mobility. Age Ageing 1995; 24: 425–28.CrossRefGoogle ScholarPubMed
23Mulrow, CD, Gerety, MB, Kanten, D, Cornell, JE, DeNino, LA, Chiodo, L, Aguilar, C, O'Neil, MB, Rosenberg, J, Solis, RM. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 1994; 271: 519–24.CrossRefGoogle ScholarPubMed
24Peterson, MJ, Giuliani, C, Morey, MC, Pieper, CF, Evenson, KR, Mercer, V, Cohen, HJ, Visser, M, Brach, JS, Kritchevsky, SB, Goodpaster, BH, Rubin, S, Satterfield, S, Newman, AB, Simonsick, EM; Health, Aging and Body Composition Study Research Group. Physical activity as a preventative factor for frailty: the Health, Aging and Body Composition Study. J Gerontol A Biol Sci Med Sci 2009; 64: 61–68.CrossRefGoogle Scholar
25Forster, A, Lambley, R, Hardy, J, Young, J, Smith, J, Green, J, Burns, E. Rehabilitation for older people in long-term care. Cochrane Database Syst Rev 2009; (1): CD004294.CrossRefGoogle Scholar
26Fiatarone, MA, Marks, EC, Ryan, ND, Meredith, CN, Lipsitz, LA, Evans, WJ. High-intensity strength training in nonagerarians: effects on skeletal muscle. JAMA 1990; 263: 3029–34.CrossRefGoogle ScholarPubMed
27De Vreede, PL, Samson, MM, van Meeteren, NL, Durrsma, SA, Verhaar, J. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized controlled trial. J Am Geriatr Soc 2005; 53: 2–10.CrossRefGoogle ScholarPubMed
28Hauer, K, Pfisterer, M, Schuler, M, Bartsch, P, Oster, P. Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Arch Physical Med Rehabil 2003; 84: 1426–32.CrossRefGoogle Scholar
29Strauss, SE, Richardson, WS, Glasziou, P, Haynes, RB.Evidence-Based Medicine: How to Practice and Teach EBM, 3rd edn.Edinburgh, Elsevier, 2005.Google Scholar
30Schulz, KF, Chalmers, I, Hayes, RJ, Altman, DG. Empirical evidence of bias: Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–12.CrossRefGoogle ScholarPubMed
31Gill, TM, Baker, DI, Gottschalk, M, Peduzzi, PN, Allore, H, Byers, A. A program to prevent functional decline in physically frail elderly people who live at home. New Engl J Med 2002; 347: 1068–74.CrossRefGoogle ScholarPubMed
32Gill, TM, Williams, CS, Tinetti, ME. Assessing risk for onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc 1995; 43: 603–9.CrossRefGoogle ScholarPubMed
33Guralnik, JM, Simonsick, EM, Ferrucci, L, Glynn, RJ, Berkman, LF, Blazer, DG, Scherr, PA, Wallace, RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49: M85–94.CrossRefGoogle Scholar
34Studenski, S, Perera, S, Patel, K, Rosano, C, Faulkner, K, Inzitari, M, Brach, J, Chandler, J, Cawthon, P, Connor, EB, Nevitt, M, Visser, M, Kritchevsky, S, Badinelli, S, Harris, T, Newman, AB, Cauley, J, Ferrucci, L, Guralnik, J. Gait speed and survival in older adults. JAMA 2011; 305: 50–58.CrossRefGoogle ScholarPubMed