Effects of physical exercise in frail older adults: a systematic review

Pillatt, Ana Paula; Nielsson, Jordana; Schneider, Rodolfo Herberto

doi:10.1590/1809-2950/18004826022019

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 26 (2) • Apr-Jun 2019 • https://doi.org/10.1590/1809-2950/18004826022019 linkcopy

Effects of physical exercise in frail older adults: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Frailty is an unstable condition related to functional decline, which affects the individual’s interaction with the environment and may cause limitation in the activities of daily living and result in loss of autonomy. This study aimed to provide a theoretical background on the effects of physical exercise on frail older people. This is a systematic review of studies published between 2011 and 2016 in the Medline, PubMed, PEDro, SciELO and Lilacs databases. After data search, 12 articles were included in the investigation, which highlight the positive effects of physical exercise on frailty, emphasizing multicomponent training with regularity of two to three times a week. We can conclude that physical exercises bring beneficial effects to frail older people in terms of quality of life and physical and cognitive aspects.

Keywords
Frail Elderly; Exercise; Health Promotion; Review

Authors	Methodological quality	Inclusion criteria	Groups	Intervention	Results
Tieland et al.¹⁸	4	Pre-frail and frail individuals, ≥65 years old.	CG: 57	IG: Resistance exercises for upper and lower limbs. Performed twice a week under personal supervision for 24 weeks. The workload began at 50% of 1-MR and increased to 75% of 1-MR.	Increased handgrip strength in both groups. Increased strength in leg extension and adduction and physical performance when compared with IG with CG.
Tieland et al.¹⁸	4	Pre-frail and frail individuals, ≥65 years old.	IG: 51
Szturm et al.¹⁹	7	65 to 85 years, MMSE>24 points, ability to understand the study and independent walking, with or without an auxiliary device.	CG:13	Participants received 16 sessions, twice a week, lasting 45 minutes. CG: Strengthening exercises, balance, gait re-education and walking without supervision. IG: Dynamic balance exercises along with computer game.	Improvements in overall balance, balance in tasks performed on spongy surface and balance in DLA were higher for IG compared with CG.
Szturm et al.¹⁹	7		IG: 14
Cadore et al.²⁰	6	≥85 years and frail.	CG: 13	CG: Passive and active movements in different joints for 30 minutes, four days a week. IG: Multi-component exercises for 12 weeks, twice a week. The program included resistance training of upper and lower limbs with progressive increase of loads (40-60% of 1MR) combined with exercises for balance and gait with functional progression.	Improvement in functional capacity, physical performance, isometric hip flexion and knee extension strength, maximal strength, cross-sectional area of the thigh, and reduction in the incidence of falls in IG.
Cadore et al.²⁰	6	≥85 years and frail.	IG: 11
Zech et al.²¹	6	65-94 years old and who agreed to participate in the study.	CG: 22	Before the intervention period, all participants took vitamin D3 for eight weeks.	Both interventions improved physical function.
			GS: 20	Both training groups completed a program of warm-up, balance, and muscle strength exercises twice a week for 12 weeks with increasing intensity. GPower: moved as quickly as possible during the concentric phase of each repetition and slowly during the eccentric phase. GStrength: performed concentric and eccentric contractions with a medium speed.
			GP: 18
Pollock et al.²²	5	older adults of both sexes, referred for risk assessment of falls.	CG+IG=56	both received supervised training three times a week, combining strength, balance and functional mobility for eight weeks. IG: performed whole-body vibration therapy session at the end of the exercise period.	Improvement in functional capacity, balance, self-report of fear of falling and quality of life in both groups. Increase in the length of the IG step in relation to the CG.
Zhang et al.²³	6	≥75 years and frail, without severe cognitive impairment and without a disease likely to be associated with a life expectancy of less than 12 months.	CG: 18	Duration of eight weeks. CG: included usual care, physical therapy (using manual appliances and techniques), and exercise routine. IG: Whole-body vibration exercise three to five times a week.	Both groups showed improvements in mobility, knee extension strength, balance, balance in DLA, and general health status.
Zhang et al.²³	6		IG: 19		But significant differences were found in some assessments, indicating that improvements in IG were more pronounced.
Daniel²⁴	4	≥65 years, pre-frail.	CG: 5	CG: instructed to continue any physical activity conducted before the study period. GExercise: aerobic exercises in the sitting position. Gwii: group exercises using a Nintendo Wii, using basic games, such as bowling, tennis and boxing. Participants also wore a weighted vest with 2% of their body weight added to the weighted vest every two weeks.	Improvements in functional physical states in both groups that underwent intervention when compared with CG.
			GE: 7
			GWii: 7	The two types of interventions were performed in groups for 45 minutes, three times a week for 15 weeks.
Giné-Garriga; Guerra; Unnithan²⁵	6	80 to 90 years and frail.	CG: 19	CG: Instructed to continue their daily activities and received their primary care. IG: training in functional circuits aiming at functional balance and inferior strength. Participants went to the training center twice a week for 12 weeks.	Improvement in the fear of falling and self-reported quality of life in IG compared with CG.
Giné-Garriga; Guerra; Unnithan²⁵	6	80 to 90 years and frail.	IG: 22
Jorgensen et al.²⁶	7	>65 years, self-reported poor to medium balance and ability to understand verbal instructions.	CG: 30	CG: instructed to wear the EVA insoles in their shoes every day throughout the study period. IG: Wii training conducted twice a week for ten weeks, with sessions lasting approximately 35 minutes aiming at balance and muscular conditioning.	Improvements in maximal isometric leg muscle strength, force-generating capacity, and functional performance in IG.
Jorgensen et al.²⁶	7		IG: 27
Cesari et al.²⁷	5	70-89 years, have a sedentary lifestyle and a higher risk of functional impairment.	CG: 211	CG: were invited to meet once a week in small groups for the first 26 weeks of the study and, thereafter, on a monthly basis. Health education was discussed and soft stretches of upper extremities were performed. IG: aerobic, strength, flexibility and balance training exercises. The intervention was organized in three following phases: weeks 1-8: three exercise sessions (40-60 minutes) per week conducted under supervision. Weeks 9-24: two supervised sessions per week and resistance, flexibility and strength exercises at home (at least three times a week). Week 25 until the end of the study: home intervention with the option of going once or twice for supervision and monthly telephone contact. For resistance, the intensity of 70% of the effort was used and, for strengthening, an intensity of 15-16 on the Borg scale.	Reductions in the number of frailty criteria associated with the intervention against CG were observed for younger and black people with frailty and multimorbidity. The sedentary behavior was the only frailty criterion that showed significant difference between the groups randomized throughout the intervention.
Cesari et al.²⁷	5		IG: 213
Langlois et al.²⁸	4	61-89 years, able to perform a low-risk physical exercise program.	CG: 36	CG: instructed to maintain their current level of activity throughout the study period. IG: One hour-long exercise training with stretching, balance, aerobic and strength for 12 weeks, three times a week. The training was performed in subgroups of three to five participants. The intensity was moderate to strong.	Improvement in functional capacity and physical resistance, cognitive processing speed, working memory, executive functions, quality of life of the IG compared with the CG. Benefits were equivalent in fragile and non-fragile participants.
Langlois et al.²⁸	4		IG: 36
Ng et al.²⁹	8	≥65 years, pre-frail or frail, able to wander without personal assistance and living at home.	GN: 44	GPhysical: Exercise was moderate, gradually increasing intensity, lasting 90 minutes, twice a week for 12 weeks, followed by 12 weeks of exercise at home. The exercise program was designed to improve strength and balance from 8 to 15 maximal repetitions (MR), or 60% to 80% of 10 MR, starting with <50% of 1 MR involving 8-10 major muscle groups. GNutrition: A commercial formula, iron and vitamin B6 folate supplement of vitamin B12 and calcium supplement, and vitamin D were provided, taken daily for 24 weeks. GCOgnition: In the first 12 weeks, participants attended weekly two-hour sessions of cognitive training designed to stimulate short-term memory, increase attention, information-processing skills, reasoning and problem-solving skills. For the subsequent 12 weeks, participants assessed the cognitive skills learned in the first 12 weeks. GCOMbined: submitted to all three interventions. CG: they had access to a standard treatment of health services and care of older adults that were normally available to older people. They received an equal volume of artificially sweetened, vanilla flavored liquid that was identical in appearance to the active nutritional supplements.	Reduction in the frailty of 15% of the participants in the CG and from 35.6% to 47.8% in the groups submitted to the intervention. The nutritional and cognition interventions reduced the frailty by three times, and the physical intervention, by four times, compared with the CG. Gain in knee strength was observed for cognition, physical and combined groups, and gains in gait speed were observed for the physical intervention group.
			GCO: 46
			GPI: 48
			GCOM: 47
			CG: 47

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Universidade de São Paulo Rua Ovídio Pires de Campos, 225 2° andar. , 05403-010 São Paulo SP / Brasil, Tel: 55 11 2661-7703, Fax 55 11 3743-7462 - São Paulo - SP - Brazil
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[TFN2] MMSE: mini mental state examination; ADL: activities of daily living; CG: control group; IG: intervention group; GS: group with strength exercises; GP: group with power exercises; GPE: physical exercise group; GWii: group with exercises using Wii; GN: group with nutritional intervention; GCO: group with cognitive intervention; GPI: group with physical intervention; GCOM: group with combined intervention; MR: maximum repetition

	“Frail Elderly” [Mesh] OR “Elderly, Frail” OR “Frail Elders” OR “Elder, Frail” OR “Elders, Frail” OR “Frail Elder” OR “Functionally-Impaired Elderly” OR “Elderly, Functionally-Impaired” OR “Functionally Impaired Elderly” OR “Frail Older Adults” OR “Adult, Frail Older” OR “Adults, Frail Older” OR “Frail Older Adult” OR “Older Adult, Frail” OR “Older Adults, Frail”
AND	“Exercise” [Mesh] OR “Exercises” OR “Exercise, Physical” OR “Exercises, Physical” OR “Physical Exercise” OR “Physical Exercises” OR “Exercise, Isometric” OR “Exercises, Isometric” OR “Isometric Exercises” OR “Isometric Exercise” OR “Exercise, Aerobic” OR “Aerobic Exercises” OR “Exercises, Aerobic” OR “Aerobic Exercise”
AND	“Clinical Trial” [Mesh] OR “Intervention Study”