Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity. Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster‐randomised clinical trial Promoting physical activity for elders with compromised function: the lifestyle Interventions and Independence for elders (LIFE) study physical activity intervention Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study. Pilot randomized controlled trial: elastic-resistance-training and lifestyle-activity intervention for sedentary older adults. Combination training and resistance training as effective interventions to improve functioning in elders. Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly Positive Effects of Physical Training in Activity of Daily Living–Dependent Older Adults Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review. Enhancing physical function in HIV-infected older adults: A randomized controlled clinical trial. Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: a randomized controlled trial. Embedding sustainable physical activities into the everyday lives of adults with intellectual disabilities: a randomised controlled trial The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial
Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made OBJECTIVES To compare the effect of high-intensity aerobic interval exercise ( HIA ) with home-based exercise ( HB ) in older adults with chronic disease soon after discharge from the hospital . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Community-dwelling older adults aged 70 to 92 ( N = 115 ) were recruited while in the hospital . After discharge , they were r and omized to HIA group ( n = 59 ) or HB ( n = 56 ) . INTERVENTION High-intensity aerobic interval exercise ( HIA ) consisted of endurance , strength , and balance exercises . The HB consisted of low-intensity exercises and telephone follow-up from a physical therapist . MEASUREMENTS Health-related quality of life ( HRQOL ) was assessed using the Medical Outcomes Study 36-item Short Form Survey , physical fitness was measured using the Senior Fitness Test , and physical activity was assessed using the Physical Activity Scale for the Elderly . RESULTS Intention-to-treat analysis showed that both groups improved their HRQOL and physical activity after 3 months . Improvements on the Senior Fitness Test ( chair st and , arm curl and 6-minute walk ( 6MWT ) ) were significantly greater in the HIA group than the HB group . The mean difference was 25.9 m on the 6MWT ( P = .001 , effect size d = 0.2 ) , 1.3 per 30 seconds on the chair st and s mean ( P = .001 , effect size d = 0.3 ) , and 1.6 per 30 seconds on the arm curl ( P = .001 , effect size d = 0.4 ) . CONCLUSION High-intensity aerobic interval exercise ( HIA ) participants significantly improved their physical fitness . Both groups increased their HRQOL and physical activity . The findings suggest that exercise therapy should be incorporated as a part of the treatment for older people at risk for functional decline Background Residents in nursing homes ( NHs ) are often frail older persons who have impaired physical activity .  Urinary incontinence ( UI ) is a common complaint for residents in NHs . Reduced functional ability and residence in NHs are documented to be risk factors for UI . Objective To investigate if an individualized training program design ed to improve activity of daily living ( ADL ) and physical capacity among residents in nursing homes has any impact on UI . Material s and methods This r and omized controlled trial was a sub study of a Nordic multicenter study . Participants had to be > 65 years , have stayed in the NH for more than 3 months and in need of assistance in at least one ADL . A total of 98 residents were r and omly allocated to either a training group ( n = 48 ) or a control group ( n = 50 ) after baseline registration s. The training program lasted for 3 months and included accommo date d physical activity and ADL training . Personal treatment goals were elicited for each subject . The control group received their usual care . The main outcome measure was UI as measured by a 24-hour pad-weighing test . There was no statistically significant difference between the groups on this measure at baseline ( P = 0.15 ) . Changes were calculated from baseline to 3 months after the end of the intervention . Results Altogether , 68 participants were included in the analysis , 35 in the intervention group and 33 in the control group . The average age was 84.3 years . The 3 months ’ postintervention adjusted mean difference between groups according to amount of leakage was 191 g ( P = 0.03 ) . This result was statistically significant after adjusting for baseline level , age , sex , and functional status . The leakage increased in residents not receiving the experimental intervention , while UI in the training group showed improvement . Conclusion The intervention group had significant better results compared with the control group after an individualized training program design ed to improve ADL and physical capacity . Further studies are needed to evaluate the effect of a goal -oriented physical training program toward NH residents UI complaints BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run The Lifestyle Interventions and Independence for Elders ( LIFE ) Study is a Phase III r and omized controlled clinical trial ( Clinical trials.gov identifier : NCT01072500 ) that will provide definitive evidence regarding the effect of physical activity ( PA ) on major  mobility disability in older adults ( 70–89 years old ) who have compromised physical function . This paper describes the methods employed in the delivery of the LIFE Study PA intervention , providing insight into how we promoted adherence and monitored the fidelity of treatment . Data are presented on participants ’ motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training . Prior to the onset of training , 31.4 % of participants noted slight conflict with being able to meet the dem and s of the program and 6.4 % indicated that the degree of conflict would be moderate . Accelerometry data collected during PA training revealed that the average intensity – 1,555 counts/minute for men and 1,237 counts/minute for women – was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults . Also , a sizable subgroup required one or more rest stops . These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function . Moreover , the concept of what constitutes “ moderate ” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription Reduction in muscle mass and physical function depends on a variety of interacting factors : age , physical activity level , nutritional state and the type and impact of disease . The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength , balance , mobility , ambulation and activities of daily living ( ADL ) in institutionalized elderly people aged 65 and over with multiple diagnoses . Baseline assessment s consisted of strength , balance , mobility/ambulation , and ADL .  Twenty-one subjects were included in the intervention program . A control group ( 21 subjects ) was first matched in pairs according to gender , age , ADL and mobility , and then by balance , ambulation and strength . The intervention program was individualized and included strength , mobility , balance and endurance training . Follow-up measures were conducted directly after the intervention and 10 weeks later . After drop-out , 20 subjects in the intervention group and 15 subjects in the control group remained for analyses . Balance and mobility improved significantly in the intervention group while declining in the control group . This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses The aim of this study was to determine the efficacy and feasibility of a resistance-training ( RT ) and lifestyle-activity program for sedentary older adults . Eligible participants ( N = 44 ) were r and omized to an 8-wk intervention or a control group . The primary outcome was lower body muscle strength , and participants completed a range of secondary outcomes . There was a significant group-by-time interaction for lower body muscle strength ( difference = 3.9 repetitions [ reps ] , 95 % CI = 2.0 - 5.8 reps ; p < .001 ; d = 1.0 ) . Changes in secondary outcomes were generally small and not statistically significant . Attendance and program satisfaction were both high . A combined elastic-tubing RT and lifestyle-activity program delivered in the community setting is an efficacious and feasible approach to improve health in sedentary older adults The purpose of the study was to determine whether resistance training ( RT ) or a combination of resistance and aerobic training ( CT ) result ed in the most improvement in measures of functional ability in functionally limited elders . Elderly adults who exhibited some limits in functional ability were r and omly assigned to either a CT , RT , or control ( C ) group . Both RT and CT exercised three times per week for 16 weeks . At Weeks 0 and 17 , participants completed six measures of strength and six functional tests . A 3 ( group ) x 3 ( time ) ANOVA with repeated measures on the time factor was used to analyze the results . CT and RT scored significantly better than C at Week 17 for biceps curl , elbow extension , chair st and , and time up the stairs . These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations Frailty has emerged as an important risk factor for disability . Age-related declines in physical and physiological function lead to increased risk of loss of independence and poor quality of life . Recent evidence has shown the effectiveness of physical exercise programmes in preventing or reversing frailty . The aim of this study was to evaluate changes in the functioning of frail elderly individuals after undergoing  resistance training  for 3 days a week for 8 weeks . The effectiveness of exercise training was investigated in 48 frail elderly individuals who were r and omly assigned to the following intervention groups : high-intensity ( HI ; n=16 ; age : 69–96 years ) or low-intensity ( LI ; n=16 ; age : 77–93 years ) strength training groups or a control group ( n=16 ; age : 76–93 years ) with no specific exercise programme . Participants were assessed for muscle strength , physical function , activities of daily living , depression and quality of life . The HI group had significantly better results ( P<0.05 ) on the Short Physical Performance Test than the LI group ; however , the LI group did show a significant improvement in those scores , whereas the scores of the control group worsened . Results for the other evaluations were similarly favourable in both exercise groups ( P>0.05 ) . The study showed that LI exercise was as effective as HI exercise for most parameters tested . Exercise training is useful for the prevention or treatment of frailty , as it improves functioning by contributing positively to muscle strength , gait , balance and quality of life The goal of this study was to determinate the effects of physical training in older adults with mobility limitations . Thirty frail women ( 84 ± 6 years ) were r and omly assigned to a training or control group for 12 weeks of upper body physical training ( UBT ) performed sitting on wheelchairs . Trained subjects showed a significant improvement in arms strength ( + 29 % ) , and shoulder flexibility ( + 10 cm ) but did not improve in arms circumference . The activities of daily living ( ADLs ) were improved ( + 77 % ) , cognitive function as defined by the Mini-Mental State Examination ( MMSE ) was maintained in the trained group ( + 3 % ) and declined in the control group ( −21 % ) . These results demonstrate that UBT in dependent older women with mobility limitations can increase strength and improve ADLs OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability This review examined effects of structured exercise ( aerobic walking , with or without complementary modes of exercise ) on cardiorespiratory measures , mobility , functional status , healthcare utilization , and quality of life in older adults ( ≥60 years ) hospitalized for acute medical illness . Inclusion required exercise protocol , at least one patient-level or utilization outcome , and at least one physical assessment point during hospitalization or within 1 month of intervention . MEDLINE , Embase , and CINAHL data bases were search ed for studies published from 2000 to March 2015 . Qualitative synthesis of 12 articles , reporting on 11 r and omized controlled trials ( RCTs ) and quasi-experimental trials described a heterogeneous set of exercise programs and reported mixed results across outcome categories . Method ological quality was independently assessed by two review ers using the Cochrane Collaboration Risk of Bias tool . Larger , well- design ed RCTs are needed , incorporating measurement of premorbid function , r and omization with intention-to-treat analysis , examination of a targeted intervention with predefined intensity , and reported adherence and attrition OBJECTIVE HIV-infected older adults ( HOA ) are at risk of functional decline . Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority . We conducted a r and omized , controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory ( SDT ) improves physical function , autonomous motivation , depression and the quality of life ( QOL ) in HOA . METHOD In total , 67 community-dwelling HOA with mild-to-moderate functional limitations were r and omized to 1 of 2 groups : a physical activity counseling group or the usual care control group . We used SDT to guide the development of the experimental intervention . Outcome measures that were collected at baseline and final study visits included a battery of physical function tests , levels of physical activity , autonomous motivation , depression , and QOL . RESULTS The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups . Overall physical performance , gait speed , measures of endurance and strength , and levels of physical activity improved in the treatment group compared to the control group ( p < .05 ) . Measures of autonomous regulation such as identified regulation , and measures of depression and QOL improved significantly in the treatment group compared with the control group ( p < .05 ) . Across the groups , improvement in intrinsic regulation and QOL correlated with an improvement in physical function ( p < .05 ) . CONCLUSION Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function , autonomous motivation , depression , and QOL in HOA with functional limitations . ( PsycINFO Data base OBJECTIVES The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life ( HRQOL ) among prefrail elderly women living in the community . DESIGN This was a r and omized controlled trial in which participants were recruited and r and omly assigned to the exercise and nutrition group ( EN , n = 30 ) , exercise only group ( E , n = 28 ) , and control group ( C , n = 31 ) . SETTING Group training classes were held at a research center in Itabashi Ward , Tokyo , Japan . PARTICIPANTS Eighty-nine prefrail women aged 70 years or older . INTERVENTION The EN group participated in an exercise training and nutritional program ( cooking class ) once a week , and the E group participated in the exercise training program only . MEASUREMENTS Outcome measures that included physical performance ( h and grip strength , balance , walking speed ) and HRQOL ( Medical Outcomes Study 36-Item Short Form Health Survey ) were obtained at entry , the end of the 12-week intervention , and 6 months after completion of the intervention program . RESULTS At the end of the 12-week intervention , significant improvements in the physical component summary score and 3 ( role physical , bodily pain , role emotional ) of the 8 domains of the Medical Outcomes Study 36-Item Short Form Health Survey were observed in the EN group . The E group exhibited a significantly increased h and grip strength at postintervention . The positive effects , however , were not maintained at 6-month follow-up , but were reduced . CONCLUSIONS The combined physical exercise training and nutritional intervention program has beneficial effects on several domains of HRQOL and h and grip strength in prefrail elderly women living in the community . However , further studies are needed to examine approaches that facilitate maintenance of the improved outcomes by combined exercise training and nutritional intervention Background Adults with intellectual disability ( ID ) are physically very inactive . This study will compare two approaches to increasing physical activity in adults with ID : a lifestyle physical activity ( light-moderate intensity ) approach and a structured exercise ( moderate-vigorous intensity ) approach . The trial will compare the short-term ( 3-month ) and long-term ( 9-month ) outcomes and sustainability of each approach with a usual-care control group . Methods / Design A three-arm r and omised controlled trial ( RCT ) will be conducted . Ninety adults with ID aged 18 - 55 will be r and omly assigned to one of three groups : 1 ) a lifestyle physical activity group ( n = 30 ) , 2 ) a structured exercise group ( n = 30 ) , or 3 ) a usual care control group ( n = 30 ) . Participants in both groups will receive a 12-week intervention delivered by exercise specialists in the community with disability service staff , after which intervention will continue for 6 months , delivered by disability service staff only . Primary outcomes are aerobic fitness , 12-hour energy expenditure , and proxy-reported everyday physical activity . Secondary outcomes include objective ly assessed physical activity and sedentary behaviour , intervention compliance , functional walking capacity , participation in domestic activities , muscle strength , body composition , psychosocial outcomes , quality of life and health care costs . Discussion The trial results will determine the effectiveness and sustainability of two approaches to increasing physical activity and exercise among adults with ID.Trial registration IS RCT N77889248 ( 18 April 2012 ) This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty Objective : Falls , loss of health-related quality of life and physical capacity , reduced participation in activities of daily living , and increased fear of falling are all potential outcomes for older adults discharged from hospital . A low-cost video based exercise programme may address this . Design : This study was a r and omized controlled trial with blinded outcomes assessment and a six-month follow-up . Subjects and setting : Participants were older adults ( > 65 years ) using a mobility aid discharged from a tertiary hospital in Brisbane , Australia , without referral for community-based rehabilitation services . Intervention : A digital video disk-based programme encompassing six exercise types each with six levels of difficulty . A home visit from a project physiotherapist was conducted to ensure patient safety . Control group patients received usual care . Main measures : Falls , health-related quality of life , participation in activities of daily living , physical capacity and fear of falling . Results : Study participants ( n = 53 , 19 intervention , 34 control ) experienced decreasing health-related quality of life , several falls ( 72 ) , and lower levels of participation in activities of daily living over the six-month follow-up . The intervention group did not differ significantly from the control group in terms of the outcomes examined , though a non-significant reduction in the rate of falls was observed . Intervention group participants complied with the exercise programme well during the first two weeks following discharge from hospital but then reduced their compliance levels thereafter . Conclusions : The intervention may be beneficial for reducing the rate of falls in this patient population though further research with a larger sample size is indicated
The conclusion is that there is firm evidence for training effects on physical fitness , functional performance , activity of daily living performance , and quality -of-life .
The objective of this study was to perform a systematic review on training outcomes influencing physical fitness , activity of daily living performance , and quality -of-life in institutionalized older people .
Our ultimate goal was to propose criteria for an evidence -based exercise protocol aim ed at improving physical fitness , activity of daily living performance , and quality -of-life of frail institutionalized older people .