Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial



      To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty.


      A randomized controlled trial with a 1:1 allocation.




      Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria.


      A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149).

      Main Outcome Measures

      FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months.


      FIM deteriorated in both groups over 12 months, −4.1 points (95% confidence interval [CI], −5.6 to −2.5) in the exercise group and −6.9 (95% CI, −8.4 to −2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, −0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity.


      One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.

      List of abbreviations:

      CI (confidence interval), FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight), IADL (instrumental activities of daily living), IQR (interquartile range), SPPB (Short Physical Performance Battery)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fried LP
        • Ferrucci L
        • Darer J
        • Williamson JD
        • Anderson G.
        Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
        • Cruz-Jentoft AJ
        • Sarcopenia Sayer AA.
        Lancet. 2019; 393: 2636-2646
        • Morley JE
        • Vellas B
        • Abellan van Kan G
        • et al.
        Frailty consensus: a call to action.
        J Am Med Dir Assoc. 2013; 14: 392-397
        • Clegg A
        • Young J
        • Illiffe S
        • Rikkert MO
        • Rockwood K.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Zhu Y
        • Liu Z
        • Wang Y
        • et al.
        Agreement between the frailty index and phenotype and their associations with falls and overnight hospitalizations.
        Arch Gerontol Geriatr. 2016; 66: 161-165
        • Fried LP
        • Tangen CM
        • Walston J
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: 146-156
        • Lozano-Montoya I
        • Correa-Pérez A
        • Abraha I
        • et al.
        Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview – the SENATOR project ONTOP Series.
        Clin Interv Aging. 2017; 12: 721-740
        • Dent E
        • Morley JE
        • Cruz-Jentoft AJ
        • et al.
        Physical frailty: ICFSR international clinical practice guidelines for identification and management.
        J Nutr Health Aging. 2019; 23: 771-787
        • Langlois F
        • Vu TTM
        • Chassé K
        • et al.
        Benefits of physical exercise training on cognition and quality of life in frail older adults.
        J Gerontol B Psychol Sci Soc Sci. 2012; 68: 400-404
        • Tarazona-Santabalbina FJ
        • Gómez-Cabrera Pérez-Ros P
        • et al.
        A multicomponent exercise intervention that reverse frailty and improves cognition, emotion and social networking in the community-dwelling frail elderly: a randomized clinical trial.
        J Am Med Dir Assoc. 2016; 17: 426-433
        • Jadczak AD
        • Makwana N
        • Luscombe-Marsh N
        • Visvanathan R
        • Schultz TJ.
        Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews.
        JBI Database System Rev Implement Rep. 2018; 16: 752-775
        • Franco MR
        • Tong A
        • Howard K
        • et al.
        Older people's perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature.
        Br J Sports Med. 2015; 49: 1268-1276
        • Stookey AD
        • Katzel LI.
        Home exercise interventions in frail older adults.
        Curr Geriatr Rep. 2020; 9: 163-175
        • Soukkio P
        • Suikkanen S
        • Kääriä S
        • et al.
        Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study).
        BMC Geriatr. 2018; 18: 232
        • Suikkanen SA
        • Soukkio PK
        • Aartolahti EM
        • et al.
        Effects of home-based physical exercise on days at home and cost-effectiveness in pre-frail and frail persons – RCT.
        J Am Med Dir Assoc. 2021; 22: 773-779
        • Morley JE
        • Malmstrom TK
        • Miller DK.
        A simple frailty questionnaire (FRAIL) predicts outcomes in middle-aged African Americans.
        J Nutr Health Aging. 2012; 16: 601-608
        • Abellan van Kan G
        • Rolland Y
        • Bergman H
        • Morley JE
        • Kritchevsky SB
        • Vellas B.
        The I.A.N.A Task Force on frailty assessment of older people in clinical practice.
        J Nutr Health Aging. 2008; 12: 29-37
        • Russell MA
        • Hill KD
        • Blackberry I
        • Day LM
        • Dharmage SC.
        The reliability and predictive accuracy of the Falls Risk for Older People in the community assessment (FROP-Com) tool.
        Age Ageing. 2008; 37: 634-639
        • Guralnik J
        • Simonsick E
        • Ferrucci L
        • et al.
        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: 85-94
        • Folstein MF
        • Folstein SE
        • McHugh PR.
        Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Granger CV
        • Hamilton BB
        • Zielezny M
        • Sherwin FS.
        Advances in functional assessment for medical rehabilitation.
        Top Geriatr Rehabil. 1986; 1: 59-74
        • Lawton MP
        • Brody EM.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Vittengl JR
        • White CN
        • McGovern RJ
        • Morton BJ.
        Comparative validity of seven scoring systems for the instrumental activities of daily living scale in rural elders.
        Aging Ment Health. 2006; 10: 40-47
        • Roberts HC
        • Denison HJ
        • Martin HJ
        • et al.
        A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.
        Age Ageing. 2011; 40: 423-429
      1. Helldán A, Helakorpi S. Health behaviour and health among the Finnish elderly, Spring 2013, with trends 1993-2013. National Institute for Health and Welfare (THL), Report 15/2014. Available at: Accessed April 13, 2021.

        • Gardner MM
        • Bucher DM
        • Robertson MC
        • Cambell AJ.
        Practical implementation of an exercise-based falls prevention programme.
        Age Ageing. 2001; 30: 70-83
        • Borg GA.
        Psychophysical bases of perceived exertion.
        Med Sci Sports Exerc. 1982; 14: 377-381
      2. Avers D, Brown M. White paper: strength training for the older adult. J Geriatr Phys Ther. 2009;32:148-52, 158.

        • Benjamini Y
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple hypothesis testing.
        J R Stat Soc B. 1995; 57: 289-300
        • Hinkka K
        • Karppi SL
        • Pohjolainen T
        • et al.
        Network-based geriatric rehabilitation for frail elderly people: feasibility and effects on subjective health and pain at one year.
        J Rehabil Med. 2007; 39: 473-478
        • Pitkälä KH
        • Pöysti MM
        • Laakkonen ML
        • et al.
        Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.
        JAMA Intern Med. 2013; 173: 894-901
        • Pavasini R
        • Guralnik J
        • Brown JC
        • et al.
        Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis.
        BMC Med. 2016; 14: 215
        • Kwon S
        • Perera S
        • Pahor M
        • et al.
        What is meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study).
        J Nutr Health Aging. 2009; 13: 538-544
        • Perera S
        • Mody SH
        • Woodman RC
        • Studenski SA.
        Meaningful change and responsiveness in common physical performance measures in older adults.
        J Am Geriatr Soc. 2005; 54: 743-749
        • Pahor M
        • Guralnik J
        • Ambrosius WT
        • et al.
        Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.
        JAMA. 2014; 311: 2387-2396
        • Arrieta H
        • Rezola-Pardo C
        • Gil SM
        • et al.
        Effects of multicomponent exercise on frailty in long-term nursing homes: a randomized controlled trial.
        J Am Geriatr Soc. 2019; 67: 1145-1151
        • Thomas S
        • Mackintosh S
        • Halbert J.
        Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis.
        Age Ageing. 2010; 39: 681-687
        • Lauretani F
        • Ticinesi A
        • Gionti L
        • et al.
        Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.
        Aging Clin Exp Res. 2019; 31: 1435-1442
        • Ashworth NL
        • Chad KE
        • Harrison EL
        • Reeder BA
        • Marshall SC.
        Home versus center based physical activity programs in older adults.
        Cochrane Database Syst Rev. 2005; 1CD004017
        • Thiebault RS
        • Funk MD
        • Abe T.
        Home-based resistance training for older adults: a systematic review.
        Geriatr Gerontol Int. 2014; 14: 750-757
        • Lacroix A
        • Hortobágyi T
        • Beurskens R
        • Granancher U.
        Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis.
        Sports Med. 2017; 47: 2341-2361
        • Bray NW
        • Smart RR
        • Jakobi JM
        • Jones GR.
        Exercise prescription to reverse frailty.
        Appl Physiol Nutr Metab. 2016; 41: 1112-1116
        • Suikkanen S
        • Soukkio P
        • Pitkälä K
        • et al.
        Older persons with signs of frailty in a home-based physical exercise intervention: baseline characteristics of an RCT.
        Aging Clin Exp Res. 2019; 31: 1419-1427
        • Hannan MT
        • Gagnon MM
        • Aneja J
        • et al.
        Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study.
        Am J Epidemiol. 2010; 171: 1031-1036
        • Prince SA
        • Adamo KB
        • Hamel ME
        • et al.
        A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review.
        Int J Behav Nutr Phys Act. 2008; 5: 56