Review Article

The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review

Table 1

Description of studies that were done in long-term care.

N (%F)
Mean age
Inclusion criteriaIntervention characteristicsOutcome measureseQualityReference

194 (71)
81
>60, living in LTC and experiencing ADL disabilitydMulticomponent one-on-one training (physical therapy), 16 weeks, 3/week, 30–45 min/sessionCognition (MMSE), depression (Geriatric Depression Scale); test batteries (physical disability index); ADL disability (Katz ADL); QOL (sickness impact profile); utilization of resources (health care cost)5[69]
191 (73)
85
>65, living in LTC and experiencing ADL disabilitydHigh-intensity functional multicomponent training (resistance, balance, and walking), 12 weeks, 2-3/week, 45 min/session, 8–12 rep based on 1RMMuscle function (lower strength); walking speed (2.4 meters test); balance (BBS); falls (incident rate)5[45, 46]
190 (84)
88
Nursing home residents, incontinencedFunctional multicomponent training (aerobic, resistance), 32 weeks, 5/week, 75% of maximum workloadBiochemical status (lymphocyte subpopulations); cardio (exercise HR); muscle function (upper strength); PA (motion sensors and staff observations); mobility endurance (walked or wheeled distance)5[70]
97 (84)
84
>65, physically restrained nursing home residents, extremely impaired both cognitively and physicallydMutlicomponent training (aerobic, resistance, mobility, and safety practice), 9 weeks, 3/week, 10% increase/weekPsychosocial state (safety score); muscle function (upper strength and endurance); flexibility (rowing ROM); mobility endurance (walk time, wheel time); chair rises (30 sec)3[68]
30 (50)
81
Living in LTC, mild cognitive impairmentdMulticomponent training (aerobic, resistance, balance, and flexibility), 4 weeksPsychosocial state (behavioral problems and use of antipsychotic and hypnotic medications)1[81]
20 (75)
88
>65, living in LTCdMulticomponent training (resistance, flexibility), 48 weeks, 3/week, 60 min/session, 1 × 5–2 × 10 repCognition (MMSE); TUG; balance (BBS); test batteries (PPT)5[71]
71
82
Living in LTCdMulticomponent training (aerobic, resistance, balance, flexibility, and coordination), 48 weeks, 2/week, 10–60 minPsychosocial state (class satisfaction); PA (daily activity level); chair rises4[93]
68 (87)
80
Living in LTCdMulticomponent training (resistance, balance, flexibility, and walking), 16 weeks, 3/week, 45 min/sessionMuscle function (lower and upper strength); flexibility (sit and reach, shoulder flexion); walking speed (7 meters test); TUG; stair climb (3 steps); balance (BBS); ADL disability (FIM)5[95]
100 (63)
87
>75, living in LTCdHigh-intensity progressive resistance training of the hip and knee extensors, 10 weeks, 3/week, 45 min/session, 3 × 8 at 80% 1RMBody composition (weight, muscle mass, muscle fiber distribution); nutrition (energy intake); biochemical (muscle damage and regeneration, central nuclei, IGF-1); muscle function (lower strength); PA (activity monitor); walking speed (6.1 meters test); stair climb (4 steps)3[4951]
22
82
>70, living in LTCdProgressive resistance training, 10 weeks, 3/week, 3 × 8 rep at 40% and 80% 1RMMuscle function (KE strength and endurance); mobility endurance (6-minute walking test); chair rises (3 times); stair climb (4 steps); ADL disability (health assessment questionnaire disability index subscale)5[82]
41 (80)
81
Living in LTCdResistance training with music, 28 weeks, 2/week, 45 min/sessionCognition (MMSE), depression (Geriatric Depression Scale); muscle function (grip strength); flexibility (KE and KF, spinal flexion ROM); chair rises; balance (postural sway); ADL disability (Barthel Index)3[79]
25 (76)
83
Living in LTCdProgressive lower body resistance training (aimed at improving muscle power), 10 weeks, 3/week, 20–60 min/sessionMuscle function (KE strength and power); walking speed (6 meters test); chair rises (30sec); TUG3[94]
21 (90)
90
Living in LTCdResistance training of knee extensors and flexors, 12 weeks, 3/week, 45 min/session, 3 × 8 rep at 50–80% 1RMBiochemical status (inflammatory markers); muscle function (KE and KF strength)2[83]
278 (68)
85
Frail and prefrail (Fried’s frailty phenotype)aFunctional walking, balance, 20 weeks, 2/week, 90 min/sessionTest Batteries (POMA, physical performance score based on 4 tests); ALD Disability (GARS); Falls (incident rate)5[80]
27 (100)
82
>70, living in LTCdVisual feedback-based balance training, 4 weeks, 3/week, 20–30 min/sessionPA (interview); balance (postural sway, weights shifting, BBS); falls (incident rate, fear of falling)3[47, 48]
32 (78)
83
Living in LTCdTreadmill walking training, 24 weeks, 1–3/week, 50–70% of the maximum speedNeurological (auditory stimulus reaction time); walking speed (10 meters test); balance (one leg stance, functional reach); falls (incident rate, time to first fall)2[87]
30
77
>65, inactivity, ADL disabilitycWater training (resistance, flexibility, activities of daily living (ADL) exercises, and relaxation), 24 weeks, 1-2/week, 60 min/session, intensity based on Borg’s RPE scaleADL disability (FIM); QOL (SF-36)5[89]
24 (63)
78
Living in LTC and experiencing ADL disabilitydWhole body vibration training, 6 weeks, 3/weekMuscle function (lower and upper strength); flexibility (back scratch, chair sit-and-reach); chair rises (30 sec); TUG; test batteries (POMA)5[84]
145 (100)
86
Living in LTCdExercise therapy using the Takizawa Program, 12 weeks, 3/weekFlexibility (shoulder, knee, ankle dorsiflex ROM); ADL disability (FIM)5[90]

aValidated operational definition of frailty.
cAt least one frailty indicator in the inclusion criteria.
dNo frailty indicators on the inclusion criteria.
eSignificant between-group differences are shown in bold.
1RM: one repetition maximum; ADL: activities of daily living; BBS: Berg balance scale: FIM, functional independence measure; GARS: Groningen activity restriction scale; HR: heart rate; IGF-I: insulin-like growth factor I; KE: knee extension; KF: knee flexion; LTC: long-term care; MMSE: minimental status exam; PA: physical activity; POMA: Tinetti performance-oriented mobility assessment; PPT: physical performance test; QOL: quality of life; rep: repetitions; ROM: range of motion; RPE: rating of perceived exertion; SF-36: medical outcomes survey short-form 36; TUG: timed up-and-go test.