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 Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge Structured exercise in older adults with limited functional ability. [Physical training as treatment of reduced functional ability in frail 75+ year-olds living at home. A randomized intervention study in general practice with technological assessment elements]. [Strength and coordination training for prevention of falls in the elderly]. Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults Positive Effects of Physical Training in Activity of Daily Living–Dependent Older Adults Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. Benefits of physical exercise training on cognition and quality of life in frail older adults. Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. Effects of multicomponent training on functional fitness in older adults. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Physical training improves motor performance in people with dementia: a randomized controlled trial.
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 Background and aims : An acute illness may place older frail people at increased risk of losing independence in functional abilities . Physical exercise may reduce the risk by improving muscle strength and balance . However , the effects of physical training on functional abilities have not been studied among frail , very old people recovering from an acute illness . The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care ( ADL ) and instrumental activities ( IADL ) relevant to daily life after discharge from hospital . Methods : This r and omized controlled trial examined 68 community-dwelling women aged 75 years or older ( mean age 83.0 , SD 3.9 ) who were hospitalized due to an acute illness , and were mobility-impaired at admission . Participants were recruited from the geriatric ward of a primary -care health-center hospital , and were r and omized into group-based strength training ( n=34 ) and control ( n=34 ) groups . The 10-week group-based intervention included strength training and functional exercises . The control group received instructions for a home exercise training program , including functional exercises but no further encouragement to exercise . The level of independence in ADL and IADL was evaluated , using a 13-item scale with stepwise grading from fully independent to fully dependent . Measurements took place immediately before and after the intervention , and three and nine months later . Results : The intervention did not have any significant main effect ( p=0.407 ) , nor was there any significant interaction between follow-up time and intervention ( p=0.854 ) . Conclusions : The multi-component outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions The authors of this study examined the effects of a 16-week exercise program design ed to increase aerobic capacity , muscular strength , and muscular endurance in older adults who reported and exhibited limited functional ability . Participants were r and omly assigned to either an  exercise ( n=39 ) or a  control ( n=34 ) group . Dependent variables tested included measures of fitness ( aerobic exercise capacity and isokinetic strength testing of the legs and arms ) and measures of functional capacity ( time to and off the floor , stair test , chair st and , and bicep curl ) . At the end of the program , there were significant differences between the exercise and control groups in arm strength , chair st and , and biceps curl . The results of this study indicate functionally limited older adults who maintain a structured exercise program for 16 weeks exhibit increased functional ability INTRODUCTION The aim of this study was to establish the value of physical training as a treatment of reduced physical ability in frail , elderly patients living at home . MATERIAL AND METHODS 46 community-dwelling frail elderly patients ( > 74 years ) participated in a r and omised , controlled intervention study . The intervention group was transported to training , whilst the control group was not activated . All had their physical functional ability determined using SF-36 , Berg 's Balance Scale , 10 m walking test and muscle strength test . RESULTS The intervention group had a significant improvement in functional ability measured by means of Berg 's Balance Scale , walking test , muscle strength test and SF-36 ( p < 0.01 ) compared with the control group . The average cost per patient was estimated at 121 DKK per training session , equivalent to 1452 DKK for a 12-week training period . DISCUSSION The establishing of a " multi-component-training " as a treatment offer , to which general practitioners could refer their patients , would involve some costs , but savings due to reduced nursing care can be expected Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention , a program for geriatric patients with falls is presented . Its aim is safer walking by an increase in muscular strength and improved coordination . The exclusion criteria and the size of the training program define a group of over 75 year old patients , who will be compared with a group with light physical exercise in a r and omized fashion . The first results show a remarkable increase in strength and a low complication rate . The functional relevance of our program remains to be proven 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 This study aim ed to evaluate the effectiveness of an innovative exercise program on muscle strength , balance , and gait kinematics in elderly community-dwellers . The exercise program included strength and balance training and the 8-form Tai Chi Chuan . The measurements were carried out at baseline and 12 weeks , and consisted of four physical performance tests , joint isokinetic strength tests , and three-dimensional gait analysis . Fifty-six community-dwelling older adults aged 60–80 years old were r and omly assigned to an intervention or control group . After 12 weeks , the intervention group showed a 17.6 % improvement in the timed up and go test , accompanied by a 54.7 % increase in the 30-second chair st and test score . Significant increases in the score of star excursion balance tests , and the strength of the extensor and flexor muscles at knee and ankle joints were also observed . In addition , the intervention group walked at a faster speed with a longer step length , shorter support phase , and a greater sagittal plane range of motion at the hip and ankle joints . No statistical improvements were seen in the control group . This study provided an effective , evidence -based falls prevention program that can be implemented in community setting s to improve physical fitness and reduce fall risks among community-dwelling older adults .  The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people 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 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 BACKGROUND Physical training to increase muscle strength and balance is considered useful for prevention of falls in older people . AIM This study compares conventional balance training with visual computer feedback training . DESIGN This was a r and omized controlled 12-week intervention trial with pre- and post-training evaluations . SETTING Out- patients referred to a geriatric falls and balance clinic . POPULATION Thirty-five patients were r and omized into two training groups . METHODS Both groups received progressive resistance muscle strength training and physical fitness training . Additionally , one group received traditional balance training and the other group received computer feedback balance training .  Strength , physical endurance , balance and falls efficacy scale scoring were assessed before and after end of training . RESULTS Twenty-seven patients ( 77 % ) were available for the evaluation ; mean compliance was 71 % . In the combined group , significant mean improvement was observed in knee extension ( 19 % ) , ankle dorsiflexion ( 16 % ) , sitting to st and ing ( 16 % ) , and in the six-minute walk test ( 8 % ) . In the traditional balance training group , the static balance in the Modified Clinical Test of Sensory Interaction and Balance st and ing on a foam mat with closed eyes showed a significant increase ( 80 % ) . No increase occurred in the computer balance training group . However , the computer feed-back training group showed a marked improvement that was up to 400 % in the training specific performance . CONCLUSION Elderly frail patients were able to increase muscle strength and physical endurance . A limited improvement was seen in the static balance tests . The computer feedback group showed a remarkable increase in training specific performance . Clinical Rehabilitation Impact OBJECTIVES Frailty is a state of vulnerability associated with increased risks of fall , hospitalization , cognitive deficits , and psychological distress . Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life . Whether frail older adults can show such benefits remains to be documented . METHOD A total of 83 participants aged 61 - 89 years were assigned to an exercise-training group ( 3 times a week for 12 weeks ) or a control group ( waiting list ) . Frailty was determined by a complete geriatric examination using specific criteria . Pre- and post-test measures assessed physical capacity , cognitive performance , and quality of life . RESULTS Compared with controls , the intervention group showed significant improvement in physical capacity ( functional capacities and physical endurance ) , cognitive performance ( executive functions , processing speed , and working memory ) , and quality of life ( global quality of life , leisure activities , physical capacity , social/family relationships , and physical health ) . Benefits were overall equivalent between frail and nonfrail participants . DISCUSSION Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to underst and the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment . Elderly individuals with balance impairment , age 65 and older , were r and omly assigned to one of three individualized training programs : single-task ( ST ) balance training ; dual-task training with fixed-priority ( FP ) instruction ; and dual-task training with variable-priority ( VP ) instruction .  Balance control during gait , under practice d and novel conditions , was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane . A smaller angle indicated better balance performance . Other outcomes included gait velocity , stride length , verbal reaction time , and rate of response . All measures were collected at baseline and the end of the 4-week training . Results indicated that all training strategies were equally effective ( P>.05 ) at improving balance performance ( smaller inclination angle ) under single-task context s. However , the VP training strategy was more effective ( P=.04 ) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies . Improved dual-task processing skills did not transfer to a novel dual-task condition . Results support Kramer et al. 's proposal that VP training improves both single-task automatization and the development of task-coordination skills The purpose of this study was to evaluate whether a 12-wk functional circuit-training program ( FCT ) could alter markers of physical frailty in a group of frail community-dwelling adults . Fifty-one individuals ( 31 women , 20 men ) , mean age ( ± SD ) 84 ( ± 2.9 ) yr , met frailty criteria and were r and omly assigned into groups ( FCT = 26 , control group [ CG ] = 25 ) . FCT underwent a 12-wk exercise program . CG met once a week for health education meetings . Measures of physical frailty , function , strength , balance , and gait speed were assessed at Weeks 0 , 12 , and 36 . Physical-frailty measures in FCT showed significant ( p < .05 ) improvements relative to those in CG ( Barthel Index at Weeks 0 and 36 : 73.41 ( ± 2.35 ) and 77.0 ( ± 2.38 ) for the FCT and 70.79 ( ± 2.53 ) and 66.73 ( ± 2.73 ) for the CG . These data indicate that an FCT program  is effective in improving measures of function and reducing physical frailty among frail older adults The purpose of this study was to evaluate the effects of a 9-week supervised multicomponent exercise program on functional fitness and body composition in independent older adults . Forty-two adults age 60 - 86 years were r and omly assigned to an exercise or a control group and were evaluated before and after training . The training program consisted of 3 sessions of walking , strengthening , and flexibility exercises per week . The multicomponent training program result ed in significant ( p < .005 ) improvements on the chair st and , arm curl , 6-min walk , and up- and -go tests . The findings of this study indicate that a 9-week training program increased upper and lower body strength , aerobic endurance , and agility/dynamic balance in older adults . The most affected components of functional fitness were lower body strength and aerobic endurance . There was no effect of the 9-week training on body composition OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls OBJECTIVES To determine whether a specific , st and ardized training regimen can improve muscle strength and physical functioning in people with dementia . DESIGN Double-blinded , r and omized , controlled trial with 3-month intervention and 3-month follow-up period in 2006 to 2009 . SETTING Outpatient geriatric rehabilitation . PARTICIPANTS Individuals with confirmed mild to moderate dementia , no severe somatic or psychological disease , and ability to walk 10 m. Most participants were still living independently with or without supportive care . INTERVENTION Supervised , progressive resistance and functional group training for 3 months specifically developed for people with dementia ( intervention , n = 62 ) compared with a low-intensity motor placebo activity ( control , n = 60 ) . MEASUREMENTS Primary outcome measures were one-repetition maximum in a leg press device for maximal strength and duration of the five-chair-st and test for functional performance . Secondary outcome measures were assessed for a number of established parameters for maximal strength , physical function , and physical activity . RESULTS Training significantly improved both primary outcomes ( percentage change from baseline : maximal strength , intervention group ( IG ) : + 51.5 ± 41.5 kg vs control group ( CG ) : -1.0 ± 28.9 kg , P < .001 ; functional performance , IG : -25.9 ± 15.1 seconds vs CG : + 11.3 ± 60.4 seconds , P < .001 ) . Secondary analysis confirmed effects for all strength and functional parameters . Training gains were partly sustained during follow-up . Low baseline performance on motor tasks but not cognitive impairment predicted positive training response . Physical activity increased significantly during the intervention ( P < .001 ) . CONCLUSION The intensive , dementia-adjusted training was feasible and substantially improved motor performance in frail , older people with dementia and may represent a model for structured rehabilitation or outpatient training
The multi-component exercise intervention composed by strength , endurance and balance training seems to be the best strategy to improve rate of falls , gait ability , balance , and strength performance in physically frail older adults
The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature , focusing specially in supervised exercise programs that improved muscle strength , fall risk , balance , and gait ability .