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Center-Based vs Home-Based Geriatric Rehabilitation on Sarcopenia Components: A Systematic Review and Meta-analysis

  • Author Footnotes
    # 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, China

    Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China

    Fujian Key Laboratory of Geriatrics, Fuzhou, China

    Fujian Provincial Center for Geriatrics, Fuzhou, China
    Search for articles by this author
  • Author Footnotes
    # Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
    Fang Wang
    Footnotes
    # Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
    Affiliations
    Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
    Search for articles by this author
  • Author Footnotes
    # Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
    Xiaoqun Liu
    Footnotes
    # Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
    Affiliations
    Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
    Search for articles by this author
  • Huijuan Zhong
    Affiliations
    Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
    Search for articles by this author
  • Feng Huang
    Affiliations
    Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China

    Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China

    Fujian Key Laboratory of Geriatrics, Fuzhou, China

    Fujian Provincial Center for Geriatrics, Fuzhou, China
    Search for articles by this author
  • Pengli Zhu
    Correspondence
    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.
    Affiliations
    Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China

    Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China

    Fujian Key Laboratory of Geriatrics, Fuzhou, China

    Fujian Provincial Center for Geriatrics, Fuzhou, China
    Search for articles by this author
  • Author Footnotes
    # Qiaowei Li, Fang Wang, and Xiaoqun Liu contributed equally to the study.
Open AccessPublished:January 10, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.016

      Abstract

      Objective

      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.

      Keywords

      List of abbreviations:

      RCTs (randomized controlled trials), GR (geriatric rehabilitation), 6MWT (6-minute walk test), TUG (Timed Up and Go)
      Sarcopenia has been defined as a progressive and generalized skeletal muscle disorder that involves accelerated loss of muscle mass and function.
      • Cruz-Jentoft AJ
      • Sayer AA
      Sarcopenia.
      In terms of human health, sarcopenia is associated with increased adverse outcomes, including falls,
      • Schaap LA
      • van Schoor NM
      • Lips P
      • Visser M.
      Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the Longitudinal Aging Study Amsterdam.
      functional decline,
      • Dos Santos L
      • Cyrino ES
      • Antunes M
      • Santos DA
      • Sardinha LB
      Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function.
      frailty, and mortality.
      • De Buyser SL
      • Petrovic M
      • Taes YE
      • et al.
      Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men.
      From a financial perspective, sarcopenia directly increases health care costs in society.
      • Steffl M
      • Sima J
      • Shiells K
      • Holmerova I.
      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).
      ,
      • Antunes AC
      • Araujo DA
      • Verissimo MT
      • Amaral TF.
      Sarcopenia and hospitalisation costs in older adults: a cross-sectional study.
      The prevalence of sarcopenia worldwide is up to 15% in healthy older adults,
      • Reijnierse EM
      • Trappenburg MC
      • Leter MJ
      • et al.
      The association between parameters of malnutrition and diagnostic measures of sarcopenia in geriatric outpatients.
      approximately 76% of acutely hospitalized older patients,
      • Reijnierse EM
      • Buljan A
      • Tuttle CSL
      • et al.
      Prevalence of sarcopenia in inpatients 70 years and older using different diagnostic criteria.
      • Cruz-Jentoft AJ
      • Landi F
      • Schneider SM
      • et al.
      Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
      • Bianchi L
      • Abete P
      • Bellelli G
      • et al.
      Prevalence and clinical correlates of sarcopenia, identified according to the EWGSOP definition and diagnostic algorithm, in hospitalized older people: the GLISTEN Study.
      and up to 69% of patients admitted to postacute geriatric rehabilitation (GR).
      • Churilov I
      • Churilov L
      • MacIsaac RJ
      • Ekinci EI.
      Systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation.
      Thus, preventing or reversing sarcopenia is an important approach in healthy aging, from both an individual and societal perspective.
      The widely accepted diagnostic criteria for sarcopenia require measurements of 3 components: muscle mass, muscle strength, and physical performance.
      • Chen LK
      • Woo J
      • Assantachai P
      • et al.
      Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
      ,
      • Cruz-Jentoft AJ
      • Bahat G
      • Bauer J
      • et al.
      Sarcopenia: revised European consensus on definition and diagnosis.
      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.
      • Cruz-Jentoft AJ
      • Landi F
      • Schneider SM
      • et al.
      Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
      ,
      • Yoshimura Y
      • Wakabayashi H
      • Yamada M
      • Kim H
      • Harada A
      • Arai H.
      Interventions for treating sarcopenia: a systematic review and meta-analysis of randomized controlled studies.
      Relevant randomized controlled trials (RCTs) showed positive effects of resistance training on muscle mass, muscle strength, and physical performance.
      • Kim H
      • Kim M
      • Kojima N
      • et al.
      Exercise and nutritional supplementation on community-dwelling elderly Japanese women with sarcopenic obesity: a randomized controlled trial.
      ,
      • Binder EF
      • Yarasheski KE
      • Steger-May K
      • et al.
      Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial.
      As an integration of multidimensional approaches to promote activity and preserve functional reserve, GR is therefore recommended for patients with geriatric syndrome.
      • Dent E
      • Morley JE
      • Cruz-Jentoft AJ
      • et al.
      International Clinical Practice Guidelines for Sarcopenia (ICFSR): screening, diagnosis and management.
      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,
      • Yoshimura Y
      • Wakabayashi H
      • Yamada M
      • Kim H
      • Harada A
      • Arai H.
      Interventions for treating sarcopenia: a systematic review and meta-analysis of randomized controlled studies.
      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,
      • Kim H
      • Kim M
      • Kojima N
      • et al.
      Exercise and nutritional supplementation on community-dwelling elderly Japanese women with sarcopenic obesity: a randomized controlled trial.
      ,
      • Kim HK
      • Suzuki T
      • Saito K
      • et al.
      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.
      • Park HK
      • Kim KH
      • Kim JH
      • Song MK
      • Choi IS
      • Han JY.
      Comparison of obesity related index and exercise capacity between center-based and home-based cardiac rehabilitation programs.
      • Bek N
      • Simsek IE
      • Erel S
      • Yakut Y
      • Uygur F.
      Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction.
      • Xia TL
      • Huang FY
      • Peng Y
      • et al.
      Efficacy of different types of exercise-based cardiac rehabilitation on coronary heart disease: a network meta-analysis.
      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.
      • Lacroix A
      • Hortobágyi T
      • Beurskens R
      • Granacher U.
      Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis.
      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.
      • Higgins JPT
      • Thomas J
      • Chandler J
      • et al.
      Cochrane Handbook for Systematic Reviews of Interventions.
      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.
      • Egger M
      • Davey Smith G
      • Schneider M
      • Minder C
      Bias in meta-analysis detected by a simple, graphical test.
      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.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Because 2 articles reported data from the same study,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      we included 24 studies in the qualitative synthesis. Twenty-one of these were finally included in the meta-analysis of the outcome.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      ,
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      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.
      • De Villar LOP
      • Domínguez BP
      • Gramage JM
      • et al.
      Comparison of intradialytic versus home-based exercise programmes on physical function, physical level and health related quality of life.
      Several trials
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      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.

      Study characteristics

      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.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      Because of a broad definition of GR, the included participants varied from healthy elderly adults to men with prostate cancer. Tsekoura et al
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      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.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      ,
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      ,
      • Meng NH.
      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.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      Five studies involved a combination of resistance and balance training.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      ,
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      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)
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      ,
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      ,
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      but seldom adopted weight equipment.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      In 14 of the studies, center-based exercise training was supervised, monitored, reviewed, or documented by physical therapists.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      ,
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      ,
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      Ten of the studies involved regular phone calls or messages to supervise the home-based training.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      ,
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Table 1Characteristics of included studies
      AuthorDesignNo. of Participants forIntention-to-Treat Analysis (CB:HB)No. of Participants for Preprotocol Analysis (CB:HB)RegionsAverage age (y)InclusionFollow-up
      Alibhai et al
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      RCT with 3 parallel groups (individual, group-based, HB)59 (39:20)42 (28:14)Canada69.9Men with prostate cancer receiving androgen deprivation therapy3, 6, 9, and 12 mo
      Almeida et al
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      RCT with 3 parallel groups (CB, HB, control)89 (45:44)76 (28:22)Brazil79.1Older adults with previous falls4 mo
      Bieler et al
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      RCT with 3 parallel groups (CB, HB, control)152 (50:52)74 (40:34)Denmark69.8Patients with clinical hip osteoarthritis2, 4, and 12 mo
      Bittar et al
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      RCT60 (30:30)34 (16:18)Brazil67.3Sedentary postmenopausal women12 mo
      Boshuizen et al
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      RCT with 3 parallel groups (CB, HB, control)73 (24:26)32 (16:16)Netherlands78.8Frail elderly persons10 wk and 6 mo
      Bourne et al
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      RCT90 (26:64)67 (21:46)UK70.3Patients with COPD7 wk
      Carmeli et al
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      RCT63 (34:29)55 (29:26)Israel70.8Elderly patients after hip surgery7 and 14 wk
      Comans et al
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      RCT107 (52:55)79 (35:41)Australia79Older fallers2 and 6 mo
      Costa et al
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      RCT25 (14:11)25 (14:11)Brazil69Prefrail older women12 wk
      Cyarto et al
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      Quasi-experimental trial with 3 parallel groups (CB, HB, control)119 (81:38)119 (81:38)Australia78.8Older adults20 wk
      Donat et al
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      RCT42 (21:21)32 (17:15)Turkey80Older adults8 wk
      Dunstan et al
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      RCT consisted of 2 phases57 (28:29)53 (27:26)Australia61.5Overweight and sedentary adults with type 2 diabetes2 and 14 mo
      Galea et al
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      RCT23 (11:12)23 (11:12)Australia67.6People after hip replacement8 wk
      Hansen et al
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      RCT134 (67:67)87 (49:42)Denmark68.3Patients with severe COPD22 wk
      Helbostad et al
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      RCT77 (39:38)53/77 (26/38:27/39)
      Number of participants included in analysis was variant in different parameters.
      Norway81Older adults with mobility and balance problems3 and 9 mo
      Hwang et al
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      RCT53 (29:24)50/49 (26/26:24/23)
      Number of participants included in analysis was variant in different parameters.
      Australia67Patients with chronic heart failure12 and 24 wk
      King et al
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      RCT with 3 parallel groups (individual, group-based, HB)59 (42:17)58 (41:17)Portland63.9Patients with Parkinson disease4 wk
      Lacroix et al
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      RCT with 3 parallel groups (supervised, unsupervised, control)44 (22:22)40/39 (21:19/18)
      Number of participants included in analysis was variant in different parameters.
      Germany73Healthy older adults12 wk
      Madsen et al
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      RCT80 (40:40)70/68 (36:34/32)
      Number of participants included in analysis was variant in different parameters.
      Denmark66.6Patients after total knee arthroplasty3 and 6 mo
      Martel et al
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      RCT with 3 parallel groups (CB, HB, control)34 (16:18)32 (16:16)Canada73.5Older adults after a minor injury2 and 12 wk
      McCarthy et al
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      RCT214 (111:103)151 (80:71)UK64.7People with knee osteoarthritis.6 and 12 mo
      Meng et al
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      RCT146 (74:72)106 (57:49)China (Taiwan)76.6Frail or prefrail older adults3 mo
      Reeder et al
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      RCT172 (84:88)152 (73:79)Canada60.4Older adults with chronic health conditions3 mo
      Tsekoura et al
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      RCT with 3 parallel groups (CB, HB, control)36 (18:18)36 (18:18)Greece72.9Elderly persons with sarcopenia12 and 24 wk
      Abbreviations: CB, center-based group; COPD, chronic obstructive pulmonary disease; HB, home-based group.
      low asterisk Number of participants included in analysis was variant in different parameters.
      Table 2Interventions of included studies
      AuthorCB InterventionCB SupervisionCB OtherHB InterventionHB SupervisionHB Other
      Alibhai et al
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      Mixed modality exercise incorporating aerobic, resistance, and flexibility training, 4-5 d/wkMonitored by a certified exercise physiologist or health coachEducationProtocol of CB interventionWeekly health coach (by smartphone) communicationsEducation component during weekly phone calls
      Almeida et al
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      Exercises included stretching, dynamic and static balancing, and resistance and dual-task exercises, 3 times/wkSupervised at centerNAProtocol of CB intervention (attended the center every other week)Monthly phone callsNA
      Bieler et al
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      Strength training, 3 times/wkSupervised by experienced physical therapistsIndividual counseling interviewHip range of motion, stretching, and strengthening exercises progressed with elastic bandsParticipants kept a training diaryNA
      Bittar et al
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      Free weight and elastic bands protocol: stretch, impact, strengthen exercise, twice/wkControlled by an attendance card on which the physiotherapist registered attendanceNAProtocol of CB intervention using an illustrated handbookTelephone by interviewer every 2 mo for 1 yNA
      Boshuizen et al
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      Exercises included a variation of concentric, isometric, and eccentric knee-extensor activity, 3 times/wkSupervised by a physical therapistNAProtocol of CB intervention (1 supervised class and 2 home sessions/wk)NANA
      Bourne et al
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      Strength training of upper and lower limbs without instruments, 2 supervised sessions and 3 times home exercise/wkNAEducational sessions presented and discussed orallyOnline exercise 2-5 times/wkPhysiotherapist leading the online program also delivered the face-to-face programsEducational sessions
      Carmeli et al
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      Exercise included active movement patterns with 8 up to 12 repetitions for leg lifts and pelvic elevation and curls, nearly 3 sessions/wkNANAProtocol of CB interventionMonitored via a phone call every other week and a once-a-month visit by therapistsNA
      Comans et al
      • Comans TA
      • Brauer SG
      • Haines TP.
      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/wkNARecommendations for home modifications and educationProtocol 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)NASame to CB
      Costa et al
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      Progressive training programs proposed to improve lower limb strength and balance, 3 times/wkGuided by physical educators or physiotherapistsNAProtocol of CB intervention (1 supervised session/wk and 2 individual sessions/wk at home)Electronic messages on the days of the exerciseNA
      Cyarto et al
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      Resistance training program, 2 sessions/wkNANAProtocol of CB intervention (1-on-1 instruction during the first month)Telephone support at the first month, recorded in a log bookNA
      Donat et al
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      Exercise program based on balance training, strengthening, and stretching of the lower limbs, 3 times/wkTracked by the physiotherapist using a common chartNAProtocol of CB interventionMeet the physiotherapist at the end of the second and fourth wkNA
      Dunstan et al
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      Resistance exercise training for 2 mo at the institute's exercise laboratory, followed by a 12-mo maintenance program, 2-3 times/wkTelephoned monthlyHealthy lifestyle information sessionProtocol of CB interventionTelephoned monthlySame to CB
      Galea et al
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      Exercises focused on functional tasks, daily living tasks, balance, strength, and endurance, twice/wkModified and recorded by a physiotherapistNAProtocol of CB intervention guided by illustrationsInstructed to keep a daily record of the exercisesNA
      Hansen et al
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      Exercise incorporated endurance and resistance training, twice/wkNAPatient education sessionsExercise sessions incorporated muscle endurance training via a videoconference software system, 3 times/wkNAPatient education sessions
      Helbostad et al
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      Progressive strength and balance training, twice/wkPhysical therapists were responsible for planning and running the programsNANonprogressive exercises, aimed at improving functional aspects of balance and strengthLocal physical therapists responsible for planning and running the programsGroup meetings
      Hwang et al
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      Aerobic and strength training exercise, 2 sessions/wkContinuously reviewed by the treating physiotherapistEducation sessionsProtocol of CB intervention guided by physiotherapist through 2-way audiovisual communicationNAEducational topics delivered as electronic slide presentations with embedded audio files
      King et al
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      Exercise with sports skill activities focused on improving basic postural system, 3 times/wkNANAIndividualized home exercise program by physical therapistNANA
      Lacroix et al
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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 homeEach session documentedNAProtocol of CB interventionControlled by phone calls every fortnightNA
      Madsen et al
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      Session consisted of strength and endurance training in machines, twice/wkSupervised by physiotherapistsEducation sessionsProtocol of CB intervention1-2 planned visits with a local physiotherapistNA
      Martel et al
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      Exercise programs included cardiovascular/aerobic exercises, strengthening and balance exercises, twice/wkNALifestyle education classesTherapist designed individual program identical in frequency, intensity, and durationMonitored by telephone

      the exercise therapist
      Lifestyle education
      McCarthy et al
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      Balance exercises, twice/wkNANAProtocol of CB intervention using the Jintronix rehabilitation softwareNANA
      Meng et al
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      Exercise program aimed at increasing lower limb strength and endurance and improving balance, twice/wkSupervised by senior physiotherapistNAExercise intervention (addressed muscle weakness, muscle fatigue, reduced locomotor function, reduced balance)NAA
      Reeder et al
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      Exercise training included stretching, aerobic and resistance training, 3 sessions/wkNANAIllustrated handouts describing calisthenics including stretching and resistance, 3 times/wkNANA
      Tsekoura et al
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Exercise sessions consisted of stretching, vigorous endurance, and light resistance training, 3 times/wkNALifestyle education classesTherapist designed individual program identical in frequency, intensity, and durationMonitored by telephoneNA
      Abbreviations: CB, center-based group; HB, home-based group; NA, not available.
      Five of the included studies reported data on muscle mass,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      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.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Among them, Cyarto et al
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      reported arm curl repetition, and Meng et al
      • Meng NH.
      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.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Bieler et al
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      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,
      • Chen LK
      • Woo J
      • Assantachai P
      • et al.
      Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
      ,
      • Cruz-Jentoft AJ
      • Bahat G
      • Bauer J
      • et al.
      Sarcopenia: revised European consensus on definition and diagnosis.
      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.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      However, 10 studies reported that center- and home-based exercise had comparable effects on muscle and physical function
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      ,
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      ,
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      ,
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      (table 3).
      Table 3Relevant outcomes, conclusion, and considerations of included studies
      AuthorRelevant OutcomeConclusionConsiderations
      Alibhai et al
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      Peak oxygen consumption, upper body strength, lower body functional capacityBenefits may be attenuated with HB programs compared with CB programs.Without raw data, not included in meta-analysis
      Almeida et al
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      400-m walk, TUG test, STSSimilar results were achieved by both trained groups.Included in meta-analysis
      Bieler et al
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      Maximal isometric hip and thigh muscle strength, muscle power, 30-second chair stand test, timed stair climbing test, 6MWTCB exercise is not superior to HB exercise for improving muscle function.Included in meta-analysis
      Bittar et al
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      Body compositionExercises under direct supervision can increase lean body mass more than exercises without direct supervision.Included in meta-analysis
      Boshuizen et al
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      Maximal knee-extensor torque, 20-m timed walking test, TUG test, box-stepping testHigh-guidance group increased more in strength than the medium-guidance group.Included in meta-analysis
      Bourne et al
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      6MWTNoninferiority of the role of online pulmonary rehabilitation to improve clinical outcomes compared with CB exercise.Included in meta-analysis
      Carmeli et al
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      25-m walk test, climbing 12 stairsCB exercise showed superior improvement in the quality of life (physical performance) compared with HB exercise.Without SD or 95% CI of relevant outcomes, not included in meta-analysis
      Comans et al
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      Muscle strength, TUG testCB 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).Included in meta-analysis
      Costa et al
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      Lower limb strength, 4-m walking test speed, STSEffects 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.Included in meta-analysis
      Cyarto et al
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      30-s STS, 30-s arm-curl test (upper body strength), 2-min step test (instead of 6MWT)Only significant difference observed among CB exercise and HB exercise was for flexibility.Included in meta-analysis
      Donat et al
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      Muscle strength, TUG testCB exercise is effective at improving balance, functional mobility, flexibility, strength, and proprioception, whereas HB exercise only improves balance.Included in meta-analysis
      Dunstan et al
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      Lean body mass, muscle strengthWith the exception of the change in lower body muscle strength, no between-group differences were observed during the maintenance period.Included in meta-analysis
      Galea et al
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      TUG test, stair climbing, 6MWT, walking speedBoth groups had similar improvements in physical function, pain, QOL, and gait.Included in meta-analysis
      Hansen et al
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      6MWD, 30-s STSSupervised HB pulmonary rehabilitation was not superior to conventional CB pulmonary rehabilitation regarding walking capacity (6MWD).Included in meta-analysis
      Helbostad et al
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      Walking speed of 3 m, STS, TUG test, muscle strengthHB exercise was effective in improving functional abilities, and supplementary individualized CB exercises did not have an additional effect.Included in meta-analysis
      Hwang et al
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      6MWD, 10-m walk test, grip strength, quadriceps strengthTelerehabilitation 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.Included in meta-analysis
      King et al
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      TUG test, stride velocityIndividual exercise and group class showed the most improvements in function, balance measures, and gait. The home exercise program improved the least across all outcomes.Included in meta-analysis
      Lacroix et al
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      Body composition (baseline), lower extremity muscle powerSupervised (CB) group showed larger effects in most investigated variables than HB group.Included in meta-analysis
      Madsen et al
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      Peak leg extensor power, 10-m walking test, 30-s STS, 5 times STSPatients receiving group-based (CB) rehabilitation do not recover faster than patients receiving supervised HB exercises in patients with total knee arthroplasty.Included in meta-analysis
      Martel et al
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      Handgrip strength, SPPB, TUG test, unipodal balance testsHB exercise using a gerontechnology had comparable effects on functional capacities, such as walking speed and 1-leg balance, as a CB exercise group program.Included in meta-analysis
      McCarthy et al
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      8-m walk time, stair ascent and descent time, muscle strengthThis finding suggests that supplementation of CB led to a short-term differential improvement in lower limb strength.Included in meta-analysis
      Meng et al
      • Meng NH.
      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 strengthHB 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.Included in meta-analysis
      Reeder et al
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      6MWT, upper and lower body muscular enduranceExamination 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
      Tsekoura et al
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Body composition, muscle strength (handgrip strength, knee muscle strength), physical function tests (walking speed, TUG test, STS)Supervised group-based (CB) exercise seems to be superior to HB exercise therapy in almost all variables.Included in meta-analysis
      Abbreviations: CB, center-based group; HB, home-based group; QOL, quality of life; SPPB, Short Physical Performance Battery; STS, sit-to-stand test.
      Supplementary Table 1Search strategy
      PubMed
      #1aged [MeSH Terms] OR aging [MeSH Terms]3,455,716
      #2older 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 #24,994,893
      #4Exercise [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
      #5resistance 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 #5669,064
      #7muscle 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
      #8Handgrip [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 #8178,947
      #10randomized 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 #106,789
      #12Rehabilitation 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 #13195,146
      #15#11 AND #141,042
      Cochrane Central Register of Controlled Trials
      #1MeSH descriptor: [Aged] explode all trees OR MeSH descriptor: [Aging] this term only214362
      #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,kw779505
      #3#1 OR #2779505
      #4MeSH 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 trees36694
      #5resistance 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,kw218777
      #6#4 OR #5220189
      #7MeSH 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,kw96638
      #9#7 or #898431
      #10(randomized controlled trial): pt OR (controlled clinical trial): pt OR (random*): ti,ab,kw OR (trial): ti,ab,kw1372412
      #11#3 AND #6 AND #9 AND #1026225
      #12MeSH descriptor: [Rehabilitation Centers] explode all trees683
      #13homebas*: 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,kw180337
      #14#12 or #13180679
      #15#11 and #14 in Trials7200
      EMBASE(ovid)
      #1'aging'/exp OR 'aged'/exp3554378
      #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,kw3370436
      #3#2 OR #15844910
      #4'exercise'/exp OR 'exercise therapy'/exp OR 'physical exertion'/exp OR 'sports'/exp OR 'endurance training'/exp OR 'resistance training'/exp582544
      #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,kw707901
      #6#4 OR #5912682
      #7'muscle strength'/exp OR 'muscle weakness'/exp OR 'muscular atrophy'/exp OR 'physical functional performance'/exp OR 'sarcopenia/prevention and control'/exp625412
      #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,kw159078
      #9#7 or #8737293
      #10'randomized controlled trial':ti,ab,kw OR 'controlled clinical trial':ti,ab,kw OR 'random*':ti,ab,kw OR 'trial':ti,ab,kw2180492
      #11#3 AND #6 AND #9 AND #108927
      #12'Rehabilitation centers'/exp17462
      #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,kw252156
      #14#12 or #13268609
      #15#11 and #141425

      Muscle mass

      Five of the included studies reported data on muscle mass,
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      with 1 of them assessing the muscle mass at 2 time points,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      while Lacroix et al
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      Participants in the other 3 studies were asked to keep an exercise diary and received telephone calls from a physiotherapist to monitor adherence.
      • Bittar ST
      • Maeda SS
      • Marone MM
      • Santili C.
      Physical exercises with free weights and elastic bands can improve body composition parameters in postmenopausal women: WEB protocol with a randomized controlled trial.
      ,
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Furthermore, the physiotherapist took 4 visits to each participant's home in the study of Tsekourac et al.
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: 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 2
      Fig 2Pooled muscle mass changes in CB and HB geriatric rehabilitation. Abbreviations: CB, center-based; HB, home-based.

      Muscle strength

      Twenty-one studies reported on muscle strength at 2-14 months of follow-up.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Beyer N.
      Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis.
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Among them, 3 studies
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      ,
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      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.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      Two of the studies applied a software or internet-based platform to guide and monitor the exercise program.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      Fig 3
      Fig 3Pooled upper limb strength changes in CB and HB geriatric rehabilitation. Abbreviations: CB, center-based; HB, home-based.
      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
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      ), this difference weakened. Of all of these studies included in the lower limb strength analysis, 2 studies
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      ,
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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.
      reported that center-based exercise had a superior effect on lower limb strength compared with home-based exercise. McCarthy et al
      • McCarthy CJ
      • Mills PM
      • Pullen R
      • et al.
      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
      • Dunstan DW
      • Vulikh E
      • Owen N
      • Jolley D
      • Shaw J
      • Zimmet P.
      Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.
      used similar telephone monitoring for both home- and center-based training.
      Fig 4
      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.

      Physical performance

      Twenty-one trials reported parameters related to physical performance.
      • Alibhai SMH
      • Santa Mina D
      • Ritvo P
      • et al.
      A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy.
      ,
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      • Carmeli E
      • Sheklow SL
      • Coleman R.
      A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      ,
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      • Reeder BA
      • Chad KE
      • Harrison EL
      • et al.
      Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      Eighteen trials were entered into the quantitative analysis (288 people in the center-based group and 257 people in the home-based group).
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.
      ,
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Bourne S
      • DeVos R
      • North M
      • et al.
      Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.
      ,
      • Comans TA
      • Brauer SG
      • Haines TP.
      Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers?.
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      • Cyarto EV
      • Brown WJ
      • Marshall AL
      • Trost SG.
      Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.
      • Donat H
      • Ozcan A.
      Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise.
      ,
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      • Hansen H
      • Bieler T
      • Beyer N
      • et al.
      Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      • Lacroix A
      • Kressig RW
      • Muehlbauer T
      • et al.
      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.
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      In consideration of variation in the methods, we summarized the indicators into 3 categories: gait speed, long-distance walking test, and TUG test.
      Ten studies
      • Boshuizen HC
      • Stemmerik L
      • Westhoff MH
      • Hopman-Rock M.
      The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly.
      ,
      • Costa SN
      • Vieira ER
      • Bento PCB.
      Effects of home- and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial.
      ,
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      ,
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      • King LA
      • Wilhelm J
      • Chen Y
      • et al.
      Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial.
      ,
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      ,
      • Martel D
      • Lauzé M
      • Agnoux A
      • et al.
      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.
      ,
      • Meng NH.
      Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: a randomized trial of supervised versus home-based programs.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      provided information on gait speed, with 4 presenting longer-term data.
      • Helbostad JL
      • Sletvold O
      • Moe-Nilssen R.
      Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A radomized study.
      ,
      • Hwang R
      • Bruning J
      • Morris NR
      • Mandrusiak A
      • Russell T.
      Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.
      ,
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      ,
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      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
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      from the analysis, the difference in gait speed between the groups was not significant. Considering the type of participants, Tsekoura
      • Tsekoura M
      • Billis E
      • Tsepis E
      • et al.
      The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial.
      was the only study targeting elderly people with sarcopenia. Two of the studies showing a trend favoring home-based exercise
      • Galea MP
      • Levinger P
      • Lythgo N
      • et al.
      A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial.
      ,
      • Madsen M
      • Larsen K
      • Madsen IK
      • Søe H
      • Hansen TB.
      Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
      were focused on patients after total hip replacement, in which low-intensity training of the hip and knee was delivered in both groups.
      Fig 5
      Fig 5Pooled gait speed changes in CB and HB geriatric rehabilitation. Abbreviations: CB, center-based; HB, home-based.
      Fig 6
      Fig 6Funnel plot for meta-analysis of gait speed change.
      Eight studies reported on the long-distance walking test,
      • Almeida TL
      • Alexander NB
      • Nyquist LV
      • et al.
      Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults.
      ,
      • Bieler T
      • Siersma V
      • Magnusson SP
      • Kjaer M
      • Christensen HE
      • Beyer N.
      In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function.