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# Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
Qiaowei Li
Footnotes
# Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
Affiliations
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, ChinaDepartment of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, ChinaFujian Key Laboratory of Geriatrics, Fuzhou, ChinaFujian Provincial Center for Geriatrics, Fuzhou, China
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, ChinaDepartment of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, ChinaFujian Key Laboratory of Geriatrics, Fuzhou, ChinaFujian Provincial Center for Geriatrics, Fuzhou, China
Corresponding author Feng Huang, MD, and Pengli Zhu, MD, Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, 134 East St, Fuzhou 350001, China.
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, ChinaDepartment of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, ChinaFujian Key Laboratory of Geriatrics, Fuzhou, ChinaFujian Provincial Center for Geriatrics, Fuzhou, China
To investigate the available evidence on the components of sarcopenia in geriatric rehabilitation and to examine whether changes in different settings are associated with sarcopenia.
Data Sources
PubMed, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and Embase were searched from initiation to August 30, 2021.
Study Selection
We included randomized controlled trials of older adults receiving geriatric rehabilitation that included strength exercise training.
Data Extraction
The following study contents were extracted: study design, patient characteristics, sample size, description of the rehabilitation setting, follow-up time point, and outcomes. The main outcomes were muscle mass, muscle strength, and physical performance.
Data Synthesis
Weighted mean difference for Timed Up and Go score and standardized mean difference for other parameters were calculated.
Conclusions
Center-based geriatric rehabilitation improved lower limb strength and Timed Up and Go test score to a greater extent than home-based geriatric rehabilitation in elderly people. Center-based training seems to show a minor superior effect on gait speed in prolonged follow-up rather than at the endpoint of intervention. To draw a stronger conclusion, further high-quality trials with standard protocols and longer follow-up are needed.
Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the Longitudinal Aging Study Amsterdam.
The increase in health care costs associated with muscle weakness in older people without long-term illnesses in the Czech Republic: results from the Survey of Health, Ageing and Retirement in Europe (SHARE).
Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
Prevalence and clinical correlates of sarcopenia, identified according to the EWGSOP definition and diagnostic algorithm, in hospitalized older people: the GLISTEN Study.
Although the algorithm and test tools have undergone some changes in last decade, the main components remain the same. The components are not only applied for diagnosis and severity determination, but also for monitoring the development of sarcopenia.
To date, physical activity, with a focus on resistance (strength) training, is endorsed as a first-line therapy to manage sarcopenia, evidenced by 2 meta-analyses.
Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
As an integration of multidimensional approaches to promote activity and preserve functional reserve, GR is therefore recommended for patients with geriatric syndrome.
Because sarcopenia is one of the manifestations of geriatric syndrome, GR with resistance training can play a role in preventing and treating functional decline related to sarcopenia. So far, GR has been offered in a diverse range of modes, such as hospital-based, home-based, or community-based modes. Although the beneficial effects of resistance training have been shown,
the implementation of care and effective therapeutic interventions of sarcopenia remain far from sufficient. Most studies on sarcopenia intervention are regarding home-based exercise training,
Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial.
which emphasizes the active role of patients, convenience of transportation, and cost-effectiveness. As an alternative approach, center-based rehabilitation has shown a superior effect in some studies on body composition, muscle strength, and reducing all-cause mortality.
There is uncertainty as to whether there are differential effects of GR on sarcopenia between center-based and home-based settings. The current review aimed to investigate available evidence on the components of sarcopenia in GR, including resistance exercise training, and to examine whether differences in settings are associated with sarcopenia.
Methods
Search strategy and selection criteria
The following electronic databases were searched from inception to August 30, 2021: PubMed, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and Embase. The language was restricted to English, and the reference list of a previous relevant review was scrutinized.
After removing duplicates, 2 researchers performed title/abstract screening independently. The eligible groups were compared, and inconsistencies were discussed and resolved. Then, the full texts of potentially eligible records were accessed by 2 authors for final determination of eligibility and data extraction. The search strategy and full search terms are shown in supplementary table S1 (available online only at http://www.archives-pmr.org/).
To be included in this review, studies had to meet the following criteria: (1) the design was RCT or quasi-RCT comparing center-based (defined as fixed public area such as a clinic, rehabilitation service, or community gym) GR with home-based GR; (2) the rehabilitation included strength or resistance exercise training; (3) the exercise intensity was comparable or approximately comparable between the 2 groups; and (4) participants were mainly older adults with an average age older than 60 years. The GR was performed in patients with a wide range of medical conditions, including fracture, joint replacement, cardiac, pulmonary, and stroke rehabilitation.
Data extraction
Data extraction was performed by 3 researchers. The following study contents were extracted: study design, patient characteristics, sample size, description of the rehabilitation setting, follow-up time point, and outcomes. The methodological quality of the individual studies was assessed in accordance with the Cochrane guidelines, focusing on the following criteria: sequence generation, allocation concealment, blinding of analysts (it was impossible to blind the participants in an exercise-based intervention), incomplete data, selective reporting, and other sources of bias.
Thus, we used the tool recommended by the Cochrane guidelines to assess the risk of bias to enhance the comparability of the risk of bias assessments between the different types of studies. The risk of bias was rated as high, low, or unclear. The extracted data were entered into Review Manager version 5.3a and checked for accuracy by 2 researchers.
Data synthesis
The meta-analysis was performed on the parameters of sarcopenia, including muscle mass, muscle strength, and physical performance. Because the aforementioned parameters were reported using different methods with a variety of units, we calculated weighted mean difference for the Timed Up and Go (TUG) test score and standardized mean difference for other continuous outcomes. When a study applied more than 1 instrument to assess the same parameter, the most appropriate and widely used measurement instrument was selected. In addition, for parts of the studies assessing the outcome at multiple points in time, we used the outcome at the endpoint of intervention and a further prolonged time point after completion of the intervention. If the number of available studies for a specific parameter was more than 10, we used subgroup analysis to show the immediate and long-term effects of the intervention. Heterogeneity between studies was first assessed by visual inspection of the forest plot. Next, we computed the Q-statistic and I2. Substantial statistical heterogeneity was assumed if the Q-statistic was significant (P<.05) and the I2 value was more than 50%. A fixed-effects meta-analysis was used, except when statistical heterogeneity was identified. In that case, the more conservative random-effects model was used and sensitivity analysis was performed by exclusion of each study 1 by 1 to evaluate the stability of results without estimation of bias from the individual study. This process allowed for identification of any single study that may have a great influence on the overall results. Funnel plots were used to explore the possibility of publication bias.
All analyses were performed using R, version 4.0.4.b
Results
Study selection
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the entire research and selection procedure in shown in fig 1. In summary, 25 of the 8896 articles met the inclusion criteria and were included in the systematic review.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Reasons for exclusion in the full-text assessment phase were incomparable exercise intensity or contents, no exercise or strength exercise intervention, or lack of a center-based exercise group. We also excluded 1 conference abstract without full text published.
contained 3 parallel groups: individual supervised exercise, group exercise, and home-based exercise. Because we aimed to compare the effects of different places on rehabilitation training, the results of individual supervised and group exercises were combined and further compared with those of home training.
The summary of the study characteristics can be found in tables 1 and 2. The mean age of the participants of the 24 studies ranged from 60.4-81.0 years, and the patients were admitted for a variety of reasons. The study designs were primarily randomized controlled trials (RCTs), with 1 quasi-RCT.
conducted the only study that compared the effect of center- and home-based rehabilitation specifically on patients with sarcopenia. Six studies investigated elderly people who were frail or who had experienced a fall, populations that are relevant to sarcopenia.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
The follow-up ranged from 2 weeks to 14 months. More than half of the total studies adopted interventions consisting of mixed exercise, incorporating aerobic (endurance), resistance, and flexibility training.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Among a variety of resistance training types, the majority of studies used the application of self-weight, elastic bands, or free weight training (dumbbells or ankle weights)
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Exercise programs consisted of balance and strength exercises and functional tasks, once/wk
NA
Recommendations for home modifications and education
Protocol of CB intervention (with identical apart from substituting outdoors walking for the indoor walking circuit and activities of daily living for the upper limb circuit)
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Training session comprised static balance exercises, dynamic balance exercises, or strength/power exercises for leg and trunk muscles, twice/wk at a local gym and once/wk at home
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
using various means, including appendicular lean mass index, lean body mass, fat free percentage, and skeletal muscle mass. Six of the studies measured upper limb strength, mostly by handgrip strength.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
reported both strength of grip and elbow flexors. The approaches for evaluating lower body strength or power were inconsistent across the studies. Two of the studies adapted the criterion standard of isokinetic dynamometry to assess knee muscle strength.
conducted measurement of maximal isometric thigh muscle strength, the 30-second chair stand test, the timed stair-climbing test, and leg extensor power measurement, which demonstrated muscle strength of the lower limbs from both static and dynamic aspects. The 30-second chair stand was the most widely used bare-handed method for evaluating lower limb strength. In terms of physical performance, gait speed, 400-m (or a longer distance) walking, and the TUB test were used most. Although these tests are all recommended by the Sarcopenia Consensus from European and Asian Working Group for Sarcopenia,
we treated them separately in the meta-analysis in consideration of the different focuses of these measurements.
Critical appraisal
A summary of the risk of bias assessment of the included studies is presented in supplemental figs S1.1 and S1.2 (available online only at http://www.archives-pmr.org/). The most frequent source of methodological bias was lack of complete blinding. However, it was impossible to blind the participants during an exercise training–based intervention. Hence, we classified the risk as low. In addition, nearly half of the studies did not describe “blinding of outcome assessment”; thus, they were classified as unclear risk. The risk of bias was judged to be low in most domains in all included studies.
Outcome
All of the included studies (total 2008 participants) compared center-based exercise with home-based exercise for at least 1 of the sarcopenia components. In general, 14 studies drew conclusions that center-based exercise showed superior improvement at least in 1 of the sarcopenia components compared with home-based exercise.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
CB exercise performed better on the primary outcome measures (falls and quality of life). The study was not powered to detect differences in these secondary measures (TUG test, reaction time, step test).
Effects of HB exercise were similar to those found for a CB exercise program. However, time to complete walking and STS tests and dual-task gait parameters improved more in the CB exercise group.
CB exercise is effective at improving balance, functional mobility, flexibility, strength, and proprioception, whereas HB exercise only improves balance.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
6MWD, 10-m walk test, grip strength, quadriceps strength
Telerehabilitation was not inferior to center-based rehabilitation program in patients with chronic heart failure on the primary measure of 6MWD change. Between-group differences for the other outcomes suggest that telerehabilitation is at least similarly effective to traditional rehabilitation.
Individual exercise and group class showed the most improvements in function, balance measures, and gait. The home exercise program improved the least across all outcomes.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Peak leg extensor power, 10-m walking test, 30-s STS, 5 times STS
Patients receiving group-based (CB) rehabilitation do not recover faster than patients receiving supervised HB exercises in patients with total knee arthroplasty.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
HB exercise using a gerontechnology had comparable effects on functional capacities, such as walking speed and 1-leg balance, as a CB exercise group program.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Body fat and lean mass percentages, strength of hand grip, elbow flexors, knee extensors and flexors, submaximal leg press strength
HB exercise program improved walking speed and strength of the limb muscles as did a supervised (CB) program, although CB group showed more improvements in the physical performance tests than HB group.
Examination of the between-group comparisons revealed that with the exception of the functional fitness test, the degree of change from baseline to 3 mo was not significantly different between the 2 programs.
Without SD or 95% CI of relevant outcomes, not included in meta-analysis
older adult* [Title/Abstract] OR older population [Title/Abstract] OR oldest [Title/Abstract] OR old [Title/Abstract] OR older [Title/Abstract] OR very old [Title/Abstract] OR elder* [Title/Abstract] OR aged [Title/Abstract] OR aging [Title/Abstract] OR seniors [Title/Abstract]
2,305612
#3
#1 OR #2
4,994,893
#4
Exercise [MeSH Terms] OR exercise therapy [MeSH Terms] OR physical exertion [MeSH Terms] OR sports [MeSH Terms] OR endurance training [MeSH Terms] OR resistance training [MeSH Terms]
384,737
#5
resistance activit* [Title/Abstract] OR aerobic activit* [Title/Abstract] OR endurance activit* [Title/Abstract] OR physical activit* [Title/Abstract] OR resistance exercis* [Title/Abstract] OR aerobic exercis* [Title/Abstract] OR endurance exercis* [Title/Abstract] OR physical exercis* [Title/Abstract] OR resistance train* [Title/Abstract] OR aerobic train* [Title/Abstract] OR endurance train* [Title/Abstract] OR physical train* [Title/Abstract] OR resistance therapy [Title/Abstract] OR aerobic therapy endurance therapy [Title/Abstract] OR physical therapy [Title/Abstract] OR resistance program* [Title/Abstract] OR aerobic program* [Title/Abstract] OR endurance program* [Title/Abstract] OR physical program* [Title/Abstract] OR resistance intervent* [Title/Abstract] OR aerobic intervent* [Title/Abstract] OR endurance intervent* [Title/Abstract] OR physical intervent* [Title/Abstract] OR exercis* [Title/Abstract] OR exercise therapy [Title/Abstract] OR exercise training [Title/Abstract] OR physical exertion [Title/Abstract] OR rehabilitation exercis* [Title/Abstract] OR sport* [Title/Abstract]
512,870
#6
#4 OR #5
669,064
#7
muscle strength [MeSH Terms] OR muscle weakness [MeSH Terms] OR muscular atrophy [MeSH Terms] OR physical functional performance [MeSH Terms] OR sarcopenia/ prevention and control [MeSH Terms]
71,571
#8
Handgrip [Title/Abstract] OR grip strength [Title/Abstract] OR muscle mass [Title/Abstract] OR muscular weakness [Title/Abstract] OR muscle wasting [Title/Abstract] OR muscle loss [Title/Abstract] OR lean body mass [Title/Abstract] OR lean mass [Title/Abstract] OR fat free mass [Title/Abstract] OR body composition [Title/Abstract] OR myopenia [Title/Abstract] OR dynapenia [Title/Abstract] OR muscle function [Title/Abstract] OR functional performanc* [Title/Abstract] OR physical performance* [Title/Abstract] OR frailty [Title/Abstract]
128,482
#9
#7 OR #8
178,947
#10
randomized controlled trial [Publication Type] OR controlled clinical trial [Publication Type] OR random* [Title/Abstract] OR trial [Title/Abstract]
1,735,834
#11
#3 AND #6 AND #9 AND #10
6,789
#12
Rehabilitation centers [MeSH Terms]
14,685
#13
"homebas*" [Title/Abstract] OR "home bas*" [Title/Abstract] OR "hospitalbas*" [Title/Abstract] OR "hospital bas*" [Title/Abstract] OR "centrebas*" [Title/Abstract] OR "centre bas*" [Title/Abstract] OR "centerbas*" [Title/Abstract] OR "center bas*" [Title/Abstract] OR "institution bas*" [Title/Abstract] OR "institutionbas*" [Title/Abstract] OR "institutional bas*" [Title/Abstract] OR "institutionalbas*" [Title/Abstract] OR "supervis*" [Title/Abstract] OR "community bas*" [Title/Abstract] OR "communitybas*" [Title/Abstract]
181,308
#14
#12 OR #13
195,146
#15
#11 AND #14
1,042
Cochrane Central Register of Controlled Trials
#1
MeSH descriptor: [Aged] explode all trees OR MeSH descriptor: [Aging] this term only
214362
#2
'older adult*': ti,ab,kw OR 'older population': ti,ab,kw OR 'oldest': ti,ab,kw OR 'old': ti,ab,kw OR 'older': ti,ab,kw OR 'very old': ti,ab,kw OR 'elder*': ti,ab,kw OR 'aged': ti,ab,kw OR 'aging': ti,ab,kw OR 'seniors': ti,ab,kw
779505
#3
#1 OR #2
779505
#4
MeSH descriptor: [Exercise] explode all trees OR MeSH descriptor: [Exercise Therapy] explode all trees OR MeSH descriptor: [Physical Exertion] explode all trees OR MeSH descriptor: [Sports] explode all trees OR MeSH descriptor: [Endurance Training] explode all trees OR MeSH descriptor: [Resistance Training] explode all trees
36694
#5
resistance activit*: ti,ab,kw OR aerobic activit*: ti,ab,kw OR endurance activit*: ti,ab,kw OR physical activit*: ti,ab,kw OR resistance exercis*: ti,ab,kw OR aerobic exercis*: ti,ab,kw OR endurance exercis*: ti,ab,kw OR physical exercis*: ti,ab,kw OR resistance train*: ti,ab,kw OR aerobic train*: ti,ab,kw OR endurance train*: ti,ab,kw OR physical train*: ti,ab,kw OR resistance therapy: ti,ab,kw OR aerobic therapy:ti,ab,kw OR endurance therapy:ti,ab,kw OR physical therapy: ti,ab,kw OR resistance program*: ti,ab,kw OR aerobic program*: ti,ab,kw OR endurance program*: ti,ab,kw OR physical program*: ti,ab,kw OR resistance intervent*: ti,ab,kw OR aerobic intervent*: ti,ab,kw OR endurance intervent*: ti,ab,kw OR physical intervent*: ti,ab,kw OR exercis*: ti,ab,kw OR exercise therapy: ti,ab,kw OR exercise training: ti,ab,kw OR physical exertion: ti,ab,kw OR rehabilitation exercis*: ti,ab,kw OR sport*: ti,ab,kw
218777
#6
#4 OR #5
220189
#7
MeSH descriptor: [muscle strength] explode all trees OR MeSH descriptor: [muscle weakness] explode all trees OR MeSH descriptor: [muscular atrophy] explode all trees OR MeSH descriptor: [physical functional performance] explode all trees OR MeSH descriptor: [Sarcopenia] explode all trees and with qualifier(s): [prevention & control - PC]
7402
#8
'handgrip': ti,ab,kw OR 'grip strength': ti,ab,kw OR 'muscle mass': ti,ab,kw OR 'muscular weakness': ti,ab,kw OR 'muscle wasting': ti,ab,kw OR 'muscle loss': ti,ab,kw OR 'lean body mass': ti,ab,kw OR 'lean mass': ti,ab,kw OR 'fat free mass': ti,ab,kw OR 'body composition': ti,ab,kw OR 'myopenia': ti,ab,kw OR 'dynapenia': ti,ab,kw OR 'muscle function': ti,ab,kw OR functional performanc*: ti,ab,kw OR physical performance*: ti,ab,kw OR 'frailty': ti,ab,kw
96638
#9
#7 or #8
98431
#10
(randomized controlled trial): pt OR (controlled clinical trial): pt OR (random*): ti,ab,kw OR (trial): ti,ab,kw
1372412
#11
#3 AND #6 AND #9 AND #10
26225
#12
MeSH descriptor: [Rehabilitation Centers] explode all trees
683
#13
homebas*: ti,ab,kw OR home bas*: ti,ab,kw OR hospitalbas*: ti,ab,kw OR hospital bas*:ti,ab,kw OR centrebas*: ti,ab,kw OR centre bas*: ti,ab,kw OR centerbas*: ti,ab,kw OR center bas*: ti,ab,kw OR institution bas*: ti,ab,kw OR institutionbas*: ti,ab,kw OR institutional bas*: ti,ab,kw OR institutionalbas*: ti,ab,kw OR supervis*: ti,ab,kw OR community bas*: ti,ab,kw OR communitybas*: ti,ab,kw
180337
#14
#12 or #13
180679
#15
#11 and #14 in Trials
7200
EMBASE(ovid)
#1
'aging'/exp OR 'aged'/exp
3554378
#2
'older adult*':ti,ab,kw OR 'older population':ti,ab,kw OR 'oldest':ti,ab,kw OR 'old':ti,ab,kw OR 'older':ti,ab,kw OR 'very old':ti,ab,kw OR 'elder*':ti,ab,kw OR 'aged':ti,ab,kw OR 'aging':ti,ab,kw OR 'seniors':ti,ab,kw
3370436
#3
#2 OR #1
5844910
#4
'exercise'/exp OR 'exercise therapy'/exp OR 'physical exertion'/exp OR 'sports'/exp OR 'endurance training'/exp OR 'resistance training'/exp
582544
#5
“resistance activit*”:ti,ab,kw OR “aerobic activit*”:ti,ab,kw OR “endurance activit*”:ti,ab,kw OR “physical activit*”:ti,ab,kw OR “resistance exercis*”:ti,ab,kw OR “aerobic exercis*”:ti,ab,kw OR “endurance exercis*”:ti,ab,kw OR “physical exercis*”:ti,ab,kw OR “resistance train*”:ti,ab,kw OR “aerobic train*”:ti,ab,kw OR “endurance train*”:ti,ab,kw OR “physical train*”:ti,ab,kw OR “resistance therapy”:ti,ab,kw OR “aerobic therapy endurance therapy”:ti,ab,kw OR “physical therapy”:ti,ab,kw OR “resistance program*”:ti,ab,kw OR “aerobic program*”:ti,ab,kw OR “endurance program*”:ti,ab,kw OR “physical program*”:ti,ab,kw OR “resistance intervent*”:ti,ab,kw OR “aerobic intervent*”:ti,ab,kw OR “endurance intervent*”:ti,ab,kw OR “physical intervent*”:ti,ab,kw OR “exercis*”:ti,ab,kw OR “exercise therapy”:ti,ab,kw OR “exercise training”:ti,ab,kw OR “physical exertion”:ti,ab,kw OR “rehabilitation exercis*”:ti,ab,kw OR “sport*”:ti,ab,kw
707901
#6
#4 OR #5
912682
#7
'muscle strength'/exp OR 'muscle weakness'/exp OR 'muscular atrophy'/exp OR 'physical functional performance'/exp OR 'sarcopenia/prevention and control'/exp
625412
#8
'handgrip':ti,ab,kw OR 'grip strength':ti,ab,kw OR 'muscle mass':ti,ab,kw OR 'muscular weakness':ti,ab,kw OR 'muscle wasting':ti,ab,kw OR 'muscle loss':ti,ab,kw OR 'lean body mass':ti,ab,kw OR 'lean mass':ti,ab,kw OR 'fat free mass':ti,ab,kw OR 'body composition':ti,ab,kw OR 'myopenia':ti,ab,kw OR 'dynapenia':ti,ab,kw OR 'muscle function':ti,ab,kw OR 'functional performanc*':ti,ab,kw OR 'physical performance*':ti,ab,kw OR 'OR frailty':ti,ab,kw
159078
#9
#7 or #8
737293
#10
'randomized controlled trial':ti,ab,kw OR 'controlled clinical trial':ti,ab,kw OR 'random*':ti,ab,kw OR 'trial':ti,ab,kw
2180492
#11
#3 AND #6 AND #9 AND #10
8927
#12
'Rehabilitation centers'/exp
17462
#13
'homebas*':ti,ab,kw OR 'home bas*':ti,ab,kw OR 'hospitalbas*':ti,ab,kw OR 'hospital bas*':ti,ab,kw OR 'centrebas*':ti,ab,kw OR 'centre bas*':ti,ab,kw OR 'centerbas*':ti,ab,kw OR 'center bas*':ti,ab,kw OR 'institution bas*':ti,ab,kw OR 'institutionbas*':ti,ab,kw OR 'institutional bas*':ti,ab,kw OR 'institutionalbas*':ti,ab,kw OR 'supervis*':ti,ab,kw OR 'community bas*':ti,ab,kw OR 'communitybas*':ti,ab,kw
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
reported only skeletal muscle mass at baseline. Thus, we used 4 studies for data pooling. One of the studies reported unsupervised home-based exercise.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
Although studies showed that mean improvement of muscle mass was slightly, but nonsignificantly, higher in center-based groups, there was no significant difference in pooled muscle mass between center- and home-based GR (fixed-effects weighted standard mean difference, 0.15 [−0.07, 0.38], heterogeneity χ2=0.33, df=4, P=.99, I2=0%) at follow-up points of 3-14 months (fig 2).
Fig 2Pooled muscle mass changes in CB and HB geriatric rehabilitation. Abbreviations: CB, center-based; HB, home-based.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
could not be included in the meta-analysis because of lack of comprehensive descriptive data. The 3 remaining studies tended to find center-based exercise more effective in building muscle strength than home-based programs. Because of the wide variation in methods of muscle strength measurement, we pooled across studies separately for the upper and lower limbs.
Figure 3 showed no evidence of differences in upper limb strength change between center- and home-based groups (fixed-effects weighted standard mean difference, 0.05 [−0.14, 0.24], heterogeneity χ2=7.70, df=5, P=.17, I2=35%). A funnel plot was visually symmetrical (Egger test, P=.79). Sensitivity analysis was consistent with the primary result. Among the studies used for upper limb strength analysis, 3 reported mixed exercise incorporating aerobic (endurance), resistance, and flexibility training.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
In terms of the lower limbs, especially the quadriceps strength, center-based exercise resulted in a stronger positive effect than seen in the home-based group, despite the application of different strength-testing technologies (fixed-effects weighted standard mean difference, 0.11 [0.01, 0.20], heterogeneity χ2=25.95, df=27, P=.52, I2=0%) (fig 4). Subgroup analysis showed that the difference was prominent at the endpoint of intervention. After a longer follow-up period (up to 10 months after the intervention
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
demonstrated a smaller difference over a longer follow-up period. In both of the studies, the participants conducted mixed exercise at least twice weekly, consisting of warm-up, weight-bearing exercise, stretching, and cooldown period in different settings. Participants in center-based group were required to attend a designated place, where supervision, advice, or assistance were provided face to face. Dunstan et al
used similar telephone monitoring for both home- and center-based training.
Fig 4Pooled lower limb strength changes in CB and HB geriatric rehabilitation stratified by intervention endpoint or a longer follow-up. Abbreviations: CB, center-based; HB, home-based.
A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury.
Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
As displayed in fig 5, there is no evidence of a significant difference in gait speed change between center-based and home-based groups (fixed-effects weighted standard mean difference, −0.12 (−0.03, 0.26), heterogeneity χ2=22.83, df=13, P=.04, I2=43%). The symmetrical funnel plot (fig 6) and Egger test (P=.50) indicate that the heterogeneity is substantial. Subgroup analysis showed that, with a longer follow-up, center-based exercise played a bigger role in the improvement of gait speed. However, when we removed the data from the study by Tsekoura et al
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Number of participants included in analysis was variant in different parameters.
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