Abstract
Objective
Data Sources
Study Selection
Data Extraction
Data Synthesis
Conclusions
Keywords
List of abbreviations:
ADL (activities of daily living), BBS (Berg Balance Scale), CI (confidence interval), MD (mean difference), RCT (randomized controlled trial), SPPB (Short Physical Performance Battery), TUG (Timed Up and Go)- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
Methods
Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration: 2011. Available at: http://www.cochrane-handbook.org. Accessed March 21, 2013.
Results

Study | N | Frailty Criteria | Control | Intervention | Frequency and Duration | Follow-up | Performance and Safety Outcomes | RoB |
---|---|---|---|---|---|---|---|---|
Boshuizen, 34 2005 | 72 | (1) Elders experiencing difficulty in getting up from a chair, and (2) maximum knee-extensor torque in both legs not superior to 87.5Nm (25-kg force). | Control group received no training and was asked to remain habitually active. | Strength exercises for the thigh muscles, with use of elastic bands. Individual SSs at a facility and home USs. Arm 1: 2 SSs + 1 US Arm 2: 1 SS + 2 USs | 60min 3 times a week for 10wk | EOI, 6mo FUP | Gait speed, tandem test, step test, TUG, GARS scale | U |
de Jong, 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 1999 | 217 | (1) Individuals who require health care, such as home care or Meals-on-Wheels service; (2) age ≥70y; (3) no regular exercise; (4) BMI<25kg/m2 on the basis of self-reported weight and height or recent weight loss; (4) no use of multivitamin supplements; and (5) ability to understand the study procedures. | Supervised social program for 90min biweekly. In the off week, they were visited at their homes. Subjects were asked not to engage in other exercise programs during the study period. | Supervised group training to maintain or improve mobility and performance of daily activities. Exercises of moderate, gradually increasing intensity comprised walking, exercise-to-music routines, skills training, stretching, and relaxation activities. | 45min, twice a week, for 17wk | EOI | Mobility score, gait speed, SPPB, fitness score, ADL score, self-care score, well-being | U |
Fairhall, 44 , 45 2012 | 241 | Adults ≥70y, with 3 or more of the CHS Frailty criteria: (1) slow gait speed, (2) weak grip strength, (3) exhaustion, (4) low energy expenditure, (5) weight loss. | Usual care available to older residents of the Hornsby Ku-ring-gai area from their general practitioner and community services, which may include medical management of health conditions, allied health input, assessment of care needs, and provision of care. | Multifactorial interdisciplinary intervention targeting the CHS frailty phenotype. Participants classified as having grip weakness, slow 4-m walk time, or low physical activity level received up to 10 home-based physiotherapy sessions and performed a targeted, goal-focused, home-based strength, balance, and endurance training regimen. Mobility aids and other equipment were recommended, if needed. For participants meeting the weight loss criterion, a clinical evaluation of nutritional intake at home was made, and home-delivered meals and nutritional supplementation were offered, if appropriate. Participants reporting exhaustion and a high score in the Geriatric Depression Scale score were referred to a psychiatrist or psychologist. If applicable, chronic disease management programs were put in place or reinforced, and medication adequacy and compliance were reviewed. | 45–60min, 3–5 weekly sessions. 10 physiotherapy sessions over 12mo | EOI | Gait speed, SPPB, mobility score, Barthel Index, Geriatric Depression Score, EQ-5D quality of life | L |
Gill, 15 , 46 , 47 , 48 2002 | 188 | (1) Individuals who required >10s to perform a rapid gait test or (2) could not stand up from a seated position in a hardback chair with their arms folded. | Educational program designed to provide attention and health education. Monthly visits for 6mo, followed by monthly follow-up telephone calls for 6 additional months. | Home training program. Periodic assessments of mobility, balance, and environmental hazards by a physical therapist, followed by individually tailored interventions that target physical impairments. Progressive exercises could be proposed for ROM, balance (10min daily), and muscle conditioning with resistant elastic bands (30min, 3 times/wk). | 45–60min assessment visits, 16 visits in 6mo | EOI, 6 mo FUP | Falls, death, fractures, adverse effects | U |
Giné-Garriga, 49 2010 | 51 | Participants verifying 1 of the following: (1) required more than 10s to perform a rapid-gait test, or (2) could not stand up 5 times from a seated position in a hardback chair with their arms folded, or (3) categorized as frail by the exhaustion criterion. | Control group subjects continued their routine daily activities and had weekly social meetings at the training facility, including four 60-min health education sessions. | Functional circuit training program focused on functional balance and lower body strength-based. Supervised group sessions held at a facility. | 45min, twice a week for 12wk | EOI, 6mo FUP | Gait speed, gait test, kick test, semitandem, 1-limb stand, standup test, modified TUG, Barthel Index, fractures, adverse effects | L |
Rejeski, 52 2008 | 412 | (1) Summary score <10 on the SPPB, (2) ability to complete the 400-m walk test within 15min without sitting and without the use of an assistive device (including a cane) or the help of another person, and (3) sedentary lifestyle. | Active control (successful aging) with group workshops on health topics and an instructor-led program (5–10min) of upper extremity stretching exercises. Weekly for 24wk, and monthly thereafter. | Physical activity program combining aerobic activities, strength, balance, and flexibility exercises. Exercise training initially center-based transitioning to home-based exercise. Ten weekly closed-group counseling sessions that focus on physical activity and prevention of physical disability. | 60min, 1–3 times a week (facility, by study phase) + 1–5 times a week (home), for 12mo | 2y EOI | 400-m walk efficacy, death, hospitalization, adverse effects | L |
Rydwik, 53 , 54 , 55 , 56 2008 | 96 | (1) Unintentional weight loss >5% during the last 12mo and/or BMI <20kg/m2, (2) low PA level graded with a PA scale. | General physical training advice to take walks 3 times per week for at least 20min, to use staircases instead of an elevator from time to time, and to do 30min of physical activity each day. General diet advice to eat 3 main courses and 2–3 between-meal snacks combined with fluid. | Group training led by an instructor comprising aerobic, muscle strength, and balance (Qigong) for 12wk in a facility. Afterwards, home-based exercises for 6mo. Subjects were encouraged to perform Qigong, functional muscle strength training and to take regular walks several times per week. | 60min, twice a week for 12wk (facility) | EOI, 6 and 21mo FUP | Leg muscle strength, tandem, 1-limb stand, step test, TUG, death, hospitalization | H |
Vestergaard, 58 2008 | 63 | (1) Unable to get outdoors without a walking aid or help, and/or (2) score ≤3 mobility-tiredness scale; and (3) able to get out of bed/chair. | Control group subjects were asked not to change their usual daily habits. | Home-based training with exercises for flexibility, balance, strength using elastic bands (upper and lower extremities), aerobic. | 26min, 3 times a week for 5mo | EOI | Gait speed, SPPB, handgrip, biceps strength, semitandem, chair rise, mobility-tiredness score, EQ-5D, EQ-VAS | H |
Villareal, 59 2011 | 107 | Obese elders had to meet 2 of the following operational criteria: (1) modified PPT of 18–32; (2) Vo2peak of 11–18mL/kg/min; or (3) difficulty in performing 2 IADL or 1 BADL. | Control group subjects did not receive advice to change their diet or activity habits and were prohibited from participating in any weight loss or exercise program. Received general information about a healthy diet in monthly visits with the staff. | Physical therapist led group training combining aerobic, resistance, flexibility, and balance exercises. | 90min, 3 times a week for 12mo | EOI, 12mo FUP | SF-36, gait speed, SPPB, total 1 RM, 1-limb stand, obstacle course, FSQ score, adverse effects | L |
Watt, 60 2011 | 74 | (1) Individuals with a low IADL score (<3/5); (2) a major orthopedic diagnosis in the lower back, pelvis, or lower extremities since the age of 50y. | Shoulder abductor stretching exercise performed at home. Participants were supervised twice each week by a rehabilitation clinician. | Hip extension stretching exercise performed at home. Participants were supervised twice each week by a rehabilitation clinician. | 8min, daily for 10wk | EOI | Gait speed | H |
Westhoff, 61 2000 | 21 | (1) Elders experiencing difficulty in getting up from a chair, and (2) maximum knee-extensor torque in both legs not >87.5Nm (25-kg force). | Control group received no training and was asked to remain habitually active. | Strength exercises for the thigh muscles, with use of elastic bands. Two individual supervised sessions at a facility and 1 home session unsupervised. | 60min, 3 times a week for 10wk | EOI, 6mo FUP | Gait speed, tandem, balance test, box stepping, GARS ADL | U |
Worm, 62 , 63 2001 | 46 | (1) Elders aged >70y; and (2) living in their home; and (3) not able to leave their home unaided or without mobility aids. | Control group was not involved in any intervention. | Group-based training at a facility consisting of flexibility, aerobic, rhythm, balance, strength, and endurance. Home-based muscle and flexibility training. | 60min, twice a week (facility) + 5–8min daily (home), for 12wk | EOI | SF-36, gait speed, shoulder abductors, BBS, step maximum speed | U |
Study | N | Frailty Criteria | Intervention 1 | Intervention 2 | Frequency and Duration | Follow-up | Performance and Safety Outcomes | RoB |
---|---|---|---|---|---|---|---|---|
Bean, 27 2004 | 21 | Individuals with SPPB scores between 4 and 10. | Small-group supervised exercise sessions in a facility. Exercises addressed major muscle groups of the trunk and limbs, emphasizing task-specific movement patterns (InVEST). Progressive resistance program using a weighted vest. | Supervised exercises at a facility consisting of slow-velocity, low-resistance exercises using body or limb weight for resistance. | 30min, 3 times a week for 12wk | EOI | Gait test, SPPB, leg press power, unilateral stance, chair rise | U |
Bean, 28 , 29 2009 | 138 | Individuals with SPPB scores between 4 and 10 who were able to climb a flight of stairs independently or using a device (eg, cane). | Small-group supervised exercise sessions in a facility. Exercises addressed major muscle groups of the trunk and limbs, emphasizing task-specific movement patterns (InVEST). Progressive resistance program using a weighted vest. | Small-group supervised exercise sessions in a facility. Exercises followed the National Institute on Aging training program. Resistance program using free weights. | 45–60min, 3 times a week for 16wk | EOI | SPPB, Late Life Function Disability Instrument | U |
Binder, 30 , 31 , 32 , 33 2002 | 119 | Individuals had to meet at least 2 of the following 3 criteria: (1) score between 18 and 32 on the modified PPT, (2) report of difficulty or need for assistance with up to 2 IADL or 1 ADL, or (3) achievement of a Vo2peak between 10 and 18mL/(kgmin). | Facility-supervised exercise program 3 times a week. 1st phase: in group format, focused on flexibility, balance, coordination, speed of reaction, and strength. 2nd phase: progressive resistance training. 3rd phase: endurance training. | Home exercise program comprising 9 activities that challenge flexibility, 2–3 times a week plus a monthly exercise class at a facility. | 9mo | EOI | SPPB, 1-limb stand, BBS, Functional Status Scale | L |
Brown, 35 2000 | 84 | Participants had to score <32 points on the PPT. | Supervised exercise program designed to challenge all major muscle groups and to enhance flexibility, balance, body handling skills, speed of reaction, coordination, and strength. 22 exercises with 3 levels of difficulty, 3 times a week for 36 sessions (about 3mo). | Home exercise performing 9 activities that challenge range of motion. Participants were invited to exercise onsite under supervision once a month. | About 3mo | EOI | Gait speed, SPPB, tandem, semitandem test, 1-limb stand, BBS, reach test | U |
Hagedorn, 50 2010 | 35 | Patients referred to a falls and balance clinic. (1) Dynamic Gait Index score <19, (2) able to see visual feedback pictures, and (3) able to follow instructions for testing and training. | Computer feedback balance training plus progressive resistance muscle strength, and physical fitness training. Balance training where participant controlled a computer game on the screen through weight shifts. Individual training held at a facility. | Traditional balance training plus progressive resistance muscle strength and physical fitness training. Balance training on different surfaces with open and closed eyes. One legged balance training, walking on a line, passing an obstacle course. Individual training held at a facility. | 90min, twice a week for 12wk | EOI | Gait test, tandem, 1-limb stand, BBS, balance test, raise test, 6-min walk test, Fall-Efficacy Scale | H |
Pollock, 51 2012 | 78 | (1) Participants had 2 or more falls in the last 12mo or (2) 1 fall plus TUG test of >15s. | Vibration group: whole-body vibration therapy session after each exercise session, consisting in 5×1-min bouts, separated by 30s of rest, on an asynchronous whole-body vibration platform. Frequency and amplitude up to 30Hz and 8-mm peak to peak. | Exercise group: supervised exercise program at a facility, focused on progressive strength, balance, and functional mobility training. | 60min, 3 times a week for 8wk | EOI, 4mo FUP | SF-12, gait speed, BBS, TUG, fear of falling score | U |
Tousignant, 57 2012 | People requiring a minimum of 3 services (ie, occupational therapy, physiotherapy, neuropsychology, nursing, or physician) and (1) referred for a recent fall problem, and (2) identified as being at high risk of fall (BBS≤49/56 and at least 1 accidental fall in the previous 6mo). | Supervised Tai Chi: movements that included a combination of body alignment and specific orientations, weight transfer, and changes of direction. | Conventional physiotherapy: balance program that consisted of weight transfer, strengthening, and walking exercises. | 60min, twice a week for 15wk | EOI | Falls, number of falls | U |
Effects of interventions



Discussion
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- de Vries N.M.
- van Ravensberg C.D.
- Hobbelen J.S.
- Olde Rikkert M.G.
- Staal J.B.
- Nijhuis-van der Sanden M.W.
- Walston J.
- Hadley E.C.
- Ferrucci L.
- et al.
- Walston J.
- Hadley E.C.
- Ferrucci L.
- et al.
Study limitations
Conclusions
Supplier
- a.CG Information, 740 Granbury Way, Alpharetta, GA 30022.
Acknowledgments
Supplemental Appendix S1. Search Strategy
Supplemental Appendix S2. Forest Plot Graphics for Exercise vs Control Comparison




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- CorrectionArchives of Physical Medicine and RehabilitationVol. 99Issue 1
- PreviewThere are several errors in the article Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A. Physical exercise interventions for improving performance-based measures of physical function in community-dwelling frail older adults: a systematic review and meta-analysis, published in Archives of Physical Medicine and Rehabilitation 2014; 95: 753-69 ( https://doi.org/10.1016/j.apmr.2013.11.007 ).
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