Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-04T15:38:58.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review

Published online by Cambridge University Press:  24 August 2011

Andrew P Clegg ,
Sally E Barber ,
John B Young ,
Anne Forster  and
Steve J Iliffe
Andrew P Clegg*
Affiliation:
Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, UK
Sally E Barber
Affiliation:
Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, UK
John B Young
Affiliation:
Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, UK
Anne Forster
Affiliation:
Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, UK
Steve J Iliffe
Affiliation:
Department of Primary Care and Population Health, University College London, UK
*
Address for correspondence: Dr Andrew Clegg, Academic Unit of Elderly Care & Rehabilitation, Bradford Institute for Health Research, Temple Bank House, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK. Email: andrewpaulclegg@yahoo.co.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Frailty is common in older age, and is associated with important adverse health outcomes, including increased risk of disability and long-term care admission.

This study aims to evaluate whether home-based exercise interventions improve outcomes for frail older people.

We searched systematically for randomized controlled trials (RCTs) and cluster RCTs, with literature searching to February 2010.

All trials that evaluated home-based exercise interventions for frail older people were eligible. Primary outcomes were mobility, quality of life and daily living activities. Secondary outcomes included long-term care admission and hospitalization.

Six RCTs involving 987 participants met the inclusion criteria. Four trials were considered of high quality. One high-quality trial reported improved disability in those with moderate but not severe frailty. Meta-analysis of long-term care admission rates identified a trend towards reduced risk. Inconsistent effects on other primary and secondary outcomes were reported in the other studies.

There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate, but not severe, frailty. There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission. Home-based exercises are a potentially simple, safe and widely applicable intervention to prevent dependency decline for frail older people.

Keywords

frailtyexercisehome-basedcommunitysystematic review
Type
Intermediate care & rehabilitation
Information
Reviews in Clinical Gerontology , Volume 22 , Issue 1 , February 2012 , pp. 68 - 78
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Walston, J, Hadley, EC, Ferrucci, L, Guralnik, JM, Newman, AB, Studenski, SA, Ershler, WB, Harris, T, Fried, LP. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006; 54: 991–1001.CrossRefGoogle Scholar
2Strandberg, TE, Pitkala, KH. Frailty in elderly people. Lancet 2007; 369: 1328–29.CrossRefGoogle ScholarPubMed
3Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.CrossRefGoogle Scholar
4Rockwood, K, Song, X, MacKnight, C, Bergman, H, Hogan, DB, McDowell, I, Mitnitski, A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–95.CrossRefGoogle ScholarPubMed
5Gillespie, LD, Robertson, MC, Gillespie, WJ, Lamb, SE, Gates, S, Cumming, RG, Rowe, BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009; (2): CD007146.CrossRefGoogle Scholar
6Lacasse, Y, Goldstein, R, Lasserson, TJ, Martin, S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006; (4): CD003793.CrossRefGoogle Scholar
7Forster, A, Lambley, R, Young, JB. Is physical rehabilitation for older people in long-term care effective? Findings from a systematic review. Age Ageing 2010; 39: 169–75.CrossRefGoogle ScholarPubMed
8Department for Work and Pensions. Focus on Older People. London: Office for National Statistics, 2004.Google Scholar
9Ashworth, NL, Chad, KE, Harrison, EL, Reeder, BA, Marshall, SC. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev 2005; (1): CD004017.CrossRefGoogle Scholar
10Podsiadlo, D, Richardson, S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–48.CrossRefGoogle Scholar
11EuroQol – a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990; 16: 199–208.Google Scholar
12Collin, C, Wade, DT, Davies, S et al. The Barthel ADL Index: a reliability study. Int Disabil Stud 1988; 10: 61–63.CrossRefGoogle ScholarPubMed
13Thomas, S, Mackintosh, S, Halbert, J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing 2010; 39: 681–87.CrossRefGoogle ScholarPubMed
14Higgins, J, Altman, D. Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions, ed. Higgins, JPT, Green, S; 2009, chapter 8. Available at: http://www.cochrane-handbook.org/CrossRefGoogle Scholar
15Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.CrossRefGoogle ScholarPubMed
16Chandler, JM, Duncan, PW, Kochersberger, G, Studenski, S. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Physical Med Rehabil 1998; 79: 24–30.CrossRefGoogle ScholarPubMed
17Gill, TM, Baker, DI, Gottschalk, M, Peduzzi, PN, Allore, H, Byers, A. A program to prevent functional decline in physically frail, elderly persons who live at home. New Engl J Med 2002; 347: 1068–74.CrossRefGoogle ScholarPubMed
18Luukinen, H, Lehtola, S, Jokelainen, J, Väänänen-Sainio, R, Lotvonen, S, Koistinen, P. Prevention of disability by exercise among the elderly: a population-based, randomized, controlled trial. Scand J Prim Health Care 2006; 24: 199–205.CrossRefGoogle ScholarPubMed
19McMurdo, ME, Johnstone, R. A randomized controlled trial of a home exercise programme for elderly people with poor mobility. Age Ageing 1995; 24: 425–28.CrossRefGoogle ScholarPubMed
20Rosie, J, Taylor, D. Sit-to-stand as home exercise for mobility-limited adults over 80 years of age – GrandStand System™ may keep you standing? Age Ageing 2007; 36: 555–62.CrossRefGoogle ScholarPubMed
21Vestergaard, S, Kronborg, C, Puggaard, L. Home-based video exercise intervention for community-dwelling frail older women: a randomized controlled trial. Aging Clin Exp Res 2008; 20: 479–86.CrossRefGoogle ScholarPubMed
22Ferrucci, L, Guralnik, JM, Studenski, S, Fried, LP, Cutler, GB Jr, Walston, JD; Interventions on Frailty Working Group. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625–34.CrossRefGoogle ScholarPubMed