Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review. A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster‐randomised clinical trial Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Intervention in informal caregivers who take care of older people after a stroke (InCARE): study protocol for a randomised trial. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. Whole body vibration for older persons: an open randomized, multicentre, parallel, clinical trial Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study. Exercise for people with cancer: a clinical practice guideline. Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512). Education for cancer-related fatigue: could talking about it make people more likely to report it? Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS). Effects of resistance and all-round, functional training on quality of life, vitality and depression of older adults living in long-term care facilities: a 'randomized' controlled trial [ISRCTN87177281] Once a week is not enough: effects of a widely implemented group based exercise programme for older adults; a randomised controlled trial The Home-Based Older People's Exercise (HOPE) trial: study protocol for a randomised controlled trial A HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial Benefits of physical exercise training on cognition and quality of life in frail older adults. Effects of Yoga on Sleep Quality and Depression in Elders in Assisted Living Facilities Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE–A Randomized Controlled Trial Preventing Falls in Physically Active Community-Dwelling Older People: A Comparison of Two Intervention Techniques Wii‐Hab for Pre‐Frail Older Adults The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging Physical activity combined with resistance training reduces symptoms of frailty in older adults: A randomized controlled trial. An evaluation of the effectiveness of a multi-modal intervention in frail and pre-frail older people with type 2 diabetes - the MID-Frail study: study protocol for a randomised controlled trial The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS).
BACKGROUND Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and long-term care admission . OBJECTIVES To evaluate whether home-based exercise interventions improve outcomes for frail older people . DATA SOURCES We search ed systematic ally for r and omised controlled trials ( RCTs ) and cluster RCTs , with literature search ing to February 2010 . STUDY SELECTION 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 hospitalisation . RESULTS 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 . CONCLUSIONS 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 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 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 AIM This study aims at describing an intervention based on informal caregivers '  skills  when taking care of older people after a stroke ( InCARE ) . BACKGROUND Most informal caregivers feel unprepared to deliver assistance in activities of daily living at home . This lack of preparedness can lead to misconceptions , burden and affect their health , which , consequently , may imply hospital readmissions or early institutionalization of the older adults . DESIGN A single blinded r and omised trial . METHODS This study will recruit 198 dyads , comprising old stroke survivors and their caregivers , who will be divided into two groups : intervention and control ( protocol approved in May 2013 ) . INCLUSION CRITERIA ( informal caregivers ) absence of cognitive impairment ; resident in the Cávado Region ; to return the informed consent ( older people ) are over 65 years of age ; have had a first stroke and ; be dependent on at least one of the self-care activities post hospital discharge . PRIMARY OUTCOME informal caregivers ' skills . SECONDARY OUTCOMES include burden and Health Quality of Life in informal caregivers ; functionality , hospital readmission and institutionalization of older people stroke survivors , measured 1 and 3 months after InCARE programme . DISCUSSION The InCARE programme will highlight new ways to underst and the feasibility of a large trial , which supports caregivers who take care of older people after a stroke . It will be expected that the level of burden decreases , thus helping informal caregivers enhance their quality of life . Also , it is expected that older people 's functionality will be improved and that hospital readmission or institutionalization may be avoided OBJECTIVE To test Comprehensive Geriatric Assessment ( CGA ) as an adjunct to usual care . DESIGN A r and omized controlled trial with 3 , 6 , and 12 months follow-up . SETTING Rural communities . PATIENTS A total of 182 of 265 frail older patients ( 52 refused , 2 withdrawn , 27 ineligible , 2 deaths ) referred by family practitioners with allocation to intervention ( n = 95 ) or usual care ( n = 87 ) . INTERVENTION Three-month implementation of CGA recommendations by a Mobile Geriatric Assessment Team ( MGAT ) with follow-up assessment s at 3 , 6 , and 12 months . Geriatric nurse assessors , blinded to group assignment , performed each assessment . MAIN OUTCOME MEASURE Goal Attainment Scaling ( GAS ) . RESULTS Baseline characteristics were comparable between groups . At 3 months , the intervention group was more likely to attain their goals ( GAS total : chi = 46.4 + /- 5.9 ; GAS outcome chi = 48.0 + /- 6.6 ) compared with controls ( total : chi = 38.7 + /- 4.1 ; outcome chi = 40.8 + /- 5.6 ) ( P < .001 ) . St and ard assessment s of function ( Barthel index , instrumental activities of daily living ) , cognition ( Mini-Mental State Examination ) , and quality of life ( modified Spitzer quality of life index ) showed no difference over 12 months . No difference in survival ( intervention : chi = 320 days , SE = 6 ; control : chi = 294 days , SE = 6 ; P = .257 ) or time to institutionalization ( intervention : 340 days , SE = 9 ; control : 342 days , SE = 8 ; log rank = 0.661 ; P = .416 ) were observed . CONCLUSIONS A MGAT can target rural dwelling , frail older persons , perform in-home CGA , and develop an intervention strategy . Although the intervention did not prolong life or delay institutionalization , clinical ly important benefits were observed Background Institutionalized older persons have a poor functional capacity . Including physical exercise in their routine activities decreases their frailty and improves their quality of life . Whole-body vibration ( WBV ) training is a type of exercise that seems beneficial in frail older persons to improve their functional mobility , but the evidence is inconclusive . This trial will compare the results of exercise with WBV and exercise without WBV in improving body balance , muscle performance and fall prevention in institutionalized older persons . Methods / Design An open , multicentre and parallel r and omized clinical trial with blinded assessment . 160 nursing home residents aged over 65 years and of both sexes will be identified to participate in the study . Participants will be central ly r and omised and allocated to interventions ( vibration or exercise group ) by telephone . The vibration group will perform static/dynamic exercises ( balance and resistance training ) on a vibratory platform ( Frequency : 30 - 35 Hz ; Amplitude : 2 - 4 mm ) over a six-week training period ( 3 sessions/week ) . The exercise group will perform the same exercise protocol but without a vibration stimuli platform . The primary outcome measure is the static/dynamic body balance . Secondary outcomes are muscle strength and , number of new falls . Follow-up measurements will be collected at 6 weeks and at 6 months after r and omization . Efficacy will be analysed on an intention-to-treat ( ITT ) basis and ' per protocol ' . The effects of the intervention will be evaluated using the " t " test , Mann-Witney test , or Chi-square test , depending on the type of outcome . The final analysis will be performed 6 weeks and 6 months after r and omization . Discussion This study will help to clarify whether WBV training improves body balance , gait mobility and muscle strength in frail older persons living in nursing homes . As far as we know , this will be the first study to evaluate the efficacy of WBV for the prevention of falls . Trial Registration Clinical Trials.gov : 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 OBJECTIVES The objective of this study was to assess the effects of a hyperproteic , hypercaloric oral nutritional supplement with prebiotic fiber , vitamin D , and calcium , plus a st and ardized physical intervention , in the functional status , strength , nutritional status , and quality of life of frail institutionalized older adults . DESIGN Multicentric prospect i ve observational study under usual clinical practice conditions . SETTING Four nursing homes from Burgos ( 2 ) , Albacete , and Madrid , Spain . PARTICIPANTS Participants included 91 institutionalized older adults ( age ≥70 ) , able to walk 50 m , and meeting at least 3 of the Fried frailty phenotype criteria . INTERVENTION Daily intake of two 200-mL bottles of an oral nutritional supplement , each bottle containing 300 kcal , 20 g protein , 3 g fiber , 500 IU vitamin D , and 480 mg calcium , plus a st and ardized physical exercise training consisting of flexibility , balance , and strengthening exercises for arms and legs , 5 days per week . MEASUREMENTS Short Physical Performance Battery ( SPPB ) , Short-Form-Late-Life Function and Disability Instrument ( SF-LLFDI ) function subscale , h and grip strength , EuroQoL-5 Dimensions visual analogic scale ( EQ5DVAS ) , weight , body mass index ( BMI ) , and Short-Form Mini Nutritional Assessment ( MNA-SF ) at baseline and 6 and 12 weeks . RESULTS Forty-eight participants ( 52.7 % ) improved at least 1 point in the SPPB at week 6 , and 44 ( 48.4 % ) did so at week 12 ; 39 participants ( 42.9 % ) improved at least 2 points in the SF-LLFDI at week 6 , and 46 ( 50.5 % ) at week 12 . Participants improved their quality of life measured with the EQ5DVAS by 6 % ( 95 % confidence interval [ CI ] 3%-10 % ) at week 6 , and by 5 % ( 95 % CI 0%-10 % ) at week 12 . They also improved their nutritional status ( weight gain , BMI increase , and higher MNA-SF scores at 6- and 12-week follow-up ) . This improvement was higher in participants with more frailty criteria , lower functional level , lower vitamin D levels , and poorer nutritional status . CONCLUSION A 12-week intervention with oral nutritional supplementation plus physical exercise improves function , nutritional status , and quality of life in frail institutionalized older adults BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients OBJECTIVE To examine the effects of an exercise program and an enriched food regimen on physical functioning of frail elderly persons . DESIGN A 17-week r and omized , placebo-controlled trial . SETTING Community . PARTICIPANTS One hundred fifty-seven independently living frail elderly ( mean age , 78.7 + /- 5.6yr ) . INTERVENTION Thirty-nine subjects participated in a twice weekly group exercise design ed to improve daily functioning ; 39 subjects daily ate foods enriched with vitamins and minerals ( at 25%-100 % of the recommended daily allowances ) ; 42 subjects exercised and ate enriched foods ; and 37 subjects served as controls . Nonexercising groups followed a social program ; nonsupplement groups received the same food products without the micronutrients . MAIN OUTCOME MEASURES Functional performance based on 6 performance tests , physical fitness based on 7 fitness tests , and disabilities based on the self-reported ability to perform 16 daily activities . RESULTS Performance sum scores were significantly enhanced in trained ( + 8 % ) compared with nontrained subjects ( -8 % ) ( difference in change : 1.9 points , p < .001 , adjusted for baseline scores ) . Fitness sum scores were significantly enhanced as well ( + 3 % in trained vs -2 % in nontrained ) ( difference in change : 0.9 points , p = .05 , adjusted for baseline scores ) . No exercise effects on the disability score were observed . Consumption of enriched products did not affect performance , fitness , or disability scores . CONCLUSION Our comprehensive exercise program , design ed for widespread applicability , enhanced physical performance and fitness in a population of frail elderly . Daily consumption of micronutrient enriched foods showed no functional benefits within 17 weeks OBJECTIVES : Human Immunodeficiency Virus ( HIV ) infection worsens the frailty of elderly people , compromising their quality of life . In this study we prospect ively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity , who engaged in a one-year progressive resistance exercise program  to compare its effects on muscular strength , physical fitness and body composition . METHODS : Exercises for major muscular groups were performed 2 times/week , under professional supervision . Strength increase was evaluated bimonthly , while body composition , lipid and glycaemic profiles ( only of those living with HIV ) and physical fitness were evaluated before and after the one-year training . RESULTS : The participants living with HIV were lighter , had smaller Body Mass Index and were initially much weaker than controls . However , their strength increased more ( 1.52 - 2.33 times the baseline values for those living with HIV x 1.21 - 1.48 times for controls , p<0.01 ) , nullifying the differences initially seen . These effects were seen independently of gender , age or baseline physical activity . In addition , those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program . These effects were slightly more pronounced among those not using protease inhibitors , although not significantly . CONCLUSIONS : Resistance exercise safely increased the strength of older patients living with HIV adults , allowing them to achieve performance levels observed among otherwise healthy controls . These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults The objective of this study is to describe the rationale , design and selected baseline results of a 2-year r and omized-controlled trial ( RCT ) on the effects of physical activity counseling in community-living older people . After a four-phase screening and data - collection process targeting all independently living people in the city center of Jyväskylä , Finl and , six hundred and thirty-two 75 - 81-year-old cognitively intact , sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were r and omized into intervention and control groups . At baseline , over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level . The desire to increase physical activity was more common ( 86 % ) among subjects with mobility limitation compared with those without ( 60 % , P=0.004 ) . The intervention group received an individualized face-to-face counseling session , followed by phone contacts every 3 months throughout the intervention . The study outcomes include physical activity level , mobility limitation , functional impairments , disability , mood , quality of life , use of services , institutionalization and mortality . The screening and recruitment process was feasible and succeeded well , and showed that unmet physical activity needs are common in older people Purpose Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy . Research on the cancer-related fatigue intervention trial ( CAN-FIT ) programme found that pre-radiotherapy fatigue information and support ( pre-RFES ) did not improve levels of fatigue , but was associated with improvements in activity-based outcomes . We aim ed to measure whether pre-RFES result ed in greater participant self-ratings of their performance of daily living activities , fatigue , quality of life and distress . Methods Thirty people undergoing radiotherapy and /or chemotherapy  were r and omly allocated to either a 1-h RFES session from the CAN-FIT programme ( delivered individually to participants and modified where necessary for patients undergoing chemotherapy ) or st and ard care . Measures were taken pre- and post-treatment and 6 weeks after completing treatment . Results There was no significant difference between groups on performance of daily living activities or ratings of distress . Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale ( −9.05 [ −18.09 ; −0.018 ] ; p < 0.05 ) and physical fatigue ( 2.86 [ 0.58 ; 5.14 ] ; p < 0.02 ) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls . Conclusions Pre-RFES delivered individually did not significantly improve participants ’ ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue . Future trials , ideally comparing individual and group education to exercise programmes or cognitive – behavioural approaches , are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse OBJECTIVES to determine whether a repetitive activities of daily living ( ADL ) activity programme improves health status , life satisfaction and mobility for older people living in residential care . DESIGN cluster r and omised controlled trial . SETTING five low-level dependency residential care homes in Auckl and , New Zeal and . PARTICIPANTS one hundred and forty-nine older residents ( mean age 84.7 years ) . INTERVENTION trained research staff worked with residents in intervention wards to set a goal and complete a functional assessment for each resident . They then design ed an individualised activity programme based on ADL and worked with residential care home staff to implement the programme into daily activities of residents . MEASUREMENTS mobility : timed-up- and -go ( TUG ) ; life satisfaction : late life satisfaction index ( LSI-Z ) ; and health status : SF-36 were assessed at baseline , 3- and 6-months follow-up . RESULTS in the intervention group the SF-36 total physical component summary ( PCS ) score improved at 3 months in comparison with the control group . There was no difference between groups on mobility measures at any time , nor any measures at 6-months follow-up . Significant contamination is likely to have affected the 6-month follow-up measures . CONCLUSIONS a repetitive ADL exercise programme may improve health status in the short term in a group of frail older people living in residential care . Further research is needed to establish sustainability of change Background Regular physical activity may improve different aspects of wellbeing in older people , such as quality of life , vitality and depression . However , there is little experimental evidence to support this assumption . Therefore , we examined the effect of different training protocol s on quality of life , vitality and depression of older adults living in long-term care facilities . Methods Subjects ( n = 173 , aged 64 to 94 years , living in long-term care facilities ) , were r and omized to six months of three different moderate-intensity group exercise training protocol s , or to an ' educational ' control condition . Exercise consisted of two 45–60-minute training sessions per week of 1 ) resistance training ; 2 ) all-round , functional training ; or 3 ) a combination of both . Perceived health , the Geriatric Depression Scale ( GDS ) , the Vitality Plus Scale ( VPS ) and the Dementia Quality of Life question naire ( DQoL ) were administered at baseline and after six months . Results In the combined training group a small but significant decline was seen in perceived health , DQoL and VPS score compared to the control group . Conclusions We conclude that neither strength training nor all-round , functional training of moderate intensity is effective in improving quality of life , vitality or depression of older people living in long-term care facilities Objectives : To determine the effects of gymnastics on the health related quality of life ( HRQoL ) and functional status of independently living people , aged 65 to 80 years .  Gymnastics formed part of the More Exercise for Seniors ( MBvO in Dutch ) programme , a group based exercise programme for older adults in the Netherl and s. It has been widely implemented since 1980 . Design : R and omised controlled trial with pretest and post-test measurements . Intervention : The exercise programme given by experienced instructors lasted 10 weeks and was given weekly ( MBvO1 ; n = 125 , six groups ) or twice weekly ( MBvO2 ; n = 68 , six groups ) . The control group ( n = 193 ) was offered a health education programme . Setting : Community dwelling of older people , with a comparatively low level of fitness as assessed with the Groningen Fitness test for the Elderly . Results : No significant effects were found on the HRQoL ( Vitality Plus Scale , TAAQoL , and R AND -36 ) and the functional status ( Physical Performance Test and the Groningen Activity Restriction Scale ) . The MBvO2 group , with a low level of physical activity at baseline , showed the only improvement found on the Vitality Plus Scale ( F = 4.53 ; p = 0.01 ) . Conclusions : MBvO gymnastics once a week did not provide benefits in HRQoL and functional status after 10 weeks . However , participants with a low level of physical activity may benefit from MBvO gymnastics if they participate twice a week . To improve the health of the general public , sedentary older adults should be recruited and encouraged to combine MBvO with the health enhancing physical activity guidelines Background Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and admission to hospital or long-term care .  Exercise interventions for frail older people have the potential to reduce the risk of these adverse outcomes by increasing muscle strength and improving mobility . Methods / Design The Home-Based Older People 's Exercise ( HOPE ) trial is a two arm , assessor blind pilot r and omised controlled trial ( RCT ) to assess the effectiveness of a 12 week exercise intervention ( the HOPE programme ) design ed to improve the mobility and functional abilities of frail older people living at home , compared with usual care . The primary outcome is the timed-up- and -go test ( TUGT ) , measured at baseline and 14 weeks post-r and omisation . Secondary outcomes include the Barthel Index of activities of daily living ( ADL ) , EuroQol Group 5-Dimension Self-Report Question naire ( EQ-5D ) quality of life measure and the geriatric depression scale ( GDS ) , measured at baseline and 14 weeks post-r and omisation . We will record baseline frailty using the Edmonton Frail Scale ( EFS ) , record falls and document muscle/joint pain . We will test the feasibility of collection of data to identify therapy re sources required for delivery of the intervention . Discussion The HOPE trial will explore and evaluate a home-based exercise intervention for frail older people . Although previous RCTs have used operationalised , non-vali date d methods of measuring frailty , the HOPE trial is , to our knowledge , the first RCT of an exercise intervention for frail older people that includes a vali date d method of frailty assessment at baseline . Trial registration IS RCT N : IS RCT Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation Background Home-based exercise programs can improve physical functioning and health status of elderly people . Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success . We developed a tablet-based system — ActiveLifestyle — that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features . Objective The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between ( 1 ) tablet-based and brochure-based interventions , ( 2 ) individual and social motivation strategies , and ( 3 ) active and inactive participants . Methods A total of 44 autonomous-living elderly people ( mean 75 , SD 6 years ) were assigned to 3 training groups : social ( tablet guided , n=14 ) , individual ( tablet guided , n=13 ) , and brochure ( brochure guided , n=17 ) . All groups joined a 12-week progressive home-based strength-balance training program . Outcome measures were gait performance under single and dual task conditions , dual task costs of walking , falls efficacy , and physical performance as measured by the Short Physical Performance Battery ( SPPB ) . Furthermore , active ( ≥75 % program compliance ) and inactive ( < 75 % program compliance ) individuals were compared based on their characteristics and outcome measures . Results The tablet groups showed significant improvements in single and dual task walking , whereas there were no significant changes observable in the brochure group . Between-groups comparisons revealed significant differences for gait velocity ( U=138.5 ; P=.03 , r=.33 ) and cadence ( U=138.5 , P=.03 r=.34 ) during dual task walking at preferred speed in favor of the tablet groups . The brochure group had more inactive participants , but this did not reach statistical significance ( U=167 , P=.06 , r=.29 ) . The active participants outperformed the inactive participants in single and dual task walking , dual task costs of walking , and SPPB scores . Significant between-groups differences were seen between the tablet groups and the brochure group , in favor of the tablet groups . Conclusions A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program . Social or individual motivation strategies were equally effective . The most prominent differences were observed between active and inactive participants . These findings suggest that in older adults a tablet-based intervention enhances training compliance ; hence , it is an effective way to improve gait Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 and 6 months . The primary outcome is change in function assessed by Short Physical Performance Battery and secondary outcomes include other measurements to assess all together the condition of frailty , which includes functionality , sedentary behaviors , cognitive and emotional status and biological markers . The present study has been approved by the Committee on Ethics in Research of the University of the Basque Country ( Humans Committee Code M10/2016/105 ; Biological Sample s Committee Code M30/2016/106 ) . Discussion Results from this research will show if ageing related functional and cognitive deterioration can be effectively prevented by physical exercise in institutionalized elders . It is expected that the results of this research will guide clinical practice in nursing home setting s , so that clinicians and policymakers can provide more evidence -based practice for the management of institutionalized elder people . Trial registration The protocol has been registered under the Australian and New Zeal and Clinical Trials Registry ( ANZCTR ) with the identifier : ACTRN12616001044415 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 Background : Being relocated to an assisted living facility can result in  sleep disturbances and depression in elders . This may be attributed to or worsened by lack of regular physical activity . Appropriate exercise programs may be an important component of quality of life in this group of transitional frail elders . Purpose : This study aim ed to test the effects of a 6-month yoga exercise program in improving sleep quality and decreasing depression in transitional frail elders living in assisted living facilities . Methods : A quasi-experimental pretest- and -posttest design was used . A convenience sample of 69 elderly residents of assisted living facilities was divided r and omly into a yoga exercise ( n = 38 ) and control group ( n = 31 ) based on residence location . A total of 55 participants completed the study . The intervention was implemented in three small groups , and each practice group was led by two pretrained certified yoga instructors three times per week at 70 min per practice session for 24 weeks . The outcome measures of sleep quality ( Pittsburgh Sleep Quality Index ) and depression state ( Taiwanese Depression Question naire ) were examined at baseline , at the 12th week , and at the 24th week of the study . Results : After 6 months of performing yoga exercises , participants ' overall sleep quality had significantly improved , whereas depression , sleep disturbances , and daytime dysfunction had decreased significantly ( p < .05 ) . In addition , participants in the intervention group had better results on all outcome indicators than those of participants in the control group ( p < .05 ) . Conclusions and Implication s for Practice : It is recommended that yoga exercise be incorporated as an activity program in assisted living facilities or in other long-term care facilities to improve sleep quality and decrease  depression  in institutionalized elders PURPOSE We wanted to assess the effectiveness of a home-based physical activity program , the Depression in Late Life Intervention Trial of Exercise ( DeLLITE ) , in improving function , quality of life , and mood in older people with depressive symptoms . METHODS We undertook a r and omized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practice s in Auckl and , New Zeal and . Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months . Primary outcome measures were function , a short physical performance battery comprising balance and mobility , and the Nottingham Extended Activities of Daily Living scale . Secondary outcome measures were quality of life , the Medical Outcomes Study 36-item short form , mood , Geriatric Depression Scale ( GDS-15 ) , physical activity , Auckl and Heart Study Physical Activity Question naire , and self-report of falls . Repeated measures analyses tested the differential impact on outcomes over 12 months ’ follow-up . RESULTS The mean age of the participants was 81 years , and 59 % were women . All participants scored in the at – risk category on the depression screen , 53 % had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases , Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline , indicating moderate or severe depression . Almost all participants , 187 ( 97 % ) , completed the trial . Overall there were no differences in the impact of the 2 interventions on outcomes . Mood and mental health related quality of life improved for both groups . CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits . Future social and activity interventions should be tested against a true usual care control Background : Falls are common in physically active older people ; however , most intervention studies have been targeted at frail older people . Objective : To evaluate the effectiveness of two intervention techniques for preventing falls in physically active community-dwelling older people . Methods : Two hundred and seventeen people ( 120 men and 97 women ) aged between 70 and 90 years recruited from a health insurance company membership data base were r and omly allocated to receive either a psychomotor intervention focusing on body awareness , body experience and coordination , a fitness intervention focusing on functional skills , strength , endurance and flexibility , or no intervention ( control group).The outcome measures were prospect i ve falls ( number of fallers , number of multiple fallers , number of falls and falls rate ) and measures of physical performance ( Timed Up and Go Test , maximal step length , sit-to-st and time , normal and fast walking speed ) . Results : At the 4-month follow-up , significant improvements in the Timed Up and Go Test and sit-to-st and times were observed for both the psychomotor and fitness intervention groups . During the 12-month follow-up period , 39 % of the participants fell at least once , and 19 % fell on multiple occasions . The proportion of fallers in the  fitness intervention group was 23 % less than in the control group ( RR = 0.77 , 95 % CI 0.60–0.97 ) , but no significant reduction in falls was observed in the psychomotor intervention group . Conclusion : A fitness training program improves some aspects of physical performance and reduces falls by 23 % in physically active older people Purpose : To examine the effectiveness of a novel intervention aim ed at decreasing indices related to frailty through systematic , Progressive Functional Rehabilitation ( PFR ) . Methods : Pre‐frail volunteers were recruited to participate in a 15 week exercise intervention or control group .  Those who met study criteria and consented were r and omized into one of three groups : control , seated exercise , or Wii ® ‐fit . Test measures were completed before and after the 15 week intervention period on all participants . Measures included : Senior Fitness Test , Body Weight , Balance Efficacy Scale , CHAMPS , Late‐Life Function and Disability Index , MOS SF‐36 . Attendance was also recorded . Results : There were improvements on several of the measures included in the Senior Fitness Test including chair st and s , arm curls , step 2 , six minute walk , sit and reach , and the timed up and go . A few participants did lose weight . All of the differences reflected improved physical functional status in the seated exercise or Wii‐fit groups compared with the control group . Discussion : Increased physical activity was beneficial for all who participated . There were improvements in physical performance scores on several of the measures on the senior fitness test in both the seated exercise and Wii‐fit groups . Participants in the Wii‐fit group also showed improvement in their reported caloric expenditure and balance confidence . Conclusion : This pilot study suggests a rehabilitation effect that was similar to the effect of community based senior fitness classes . A home video game console system with weight vest could be an effective alternative for pre‐frail senior adults to group exercise classes Objective To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo ( Spain ) . Methods Data were taken from the Toledo Study for Healthy Aging , a population -based study conducted on 2,488 individuals aged 65 years and older . Study participants were selected by a two-stage r and om sampling from the municipal census of Toledo , covering both institutionalized and community dwelling persons from rural and urban setting s. Data were collected from 2006 to 2009 , and included information on social support , activities of daily living , comorbidity , physical activity , quality of life , depressive symptoms , and cognitive function . In addition , a nurse collected  anthropometric data  , conducted tests of physical performance ( walk speed , upper and lower extremities strength , and the st and - and -sit from a chair test ) and obtained a blood sample . The diagnosis of the frailty syndrome was based on the Fried criteria ( weakness , low speed , low physical activity , exhaustion , and weight loss ) . Results In total , 41.8 % ( 95 % confidence interval [ CI ] 39.4–44.2 % ) of the study participants were prefrail , and 8.4 % ( 95 % CI 7.1–9.8 % ) were frail . There were no differences in the prevalence of frailty by sex , level of education , occupation , marital status , or place of residence . The frequency of the frailty syndrome increased with age , and was higher in those with disability , depression , hip fracture and other comorbidity , such as cardiovascular disease and disorders of the central nervous system . Conclusions The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other population s in the Mediterranean basin INTRODUCTION Increased physical activity ( PA ) is a crucial factor in the prevention of physical deterioration , and resistance training ( RT ) is also a common and effective intervention for older adults . However , the effects of PA as an adjunct to RT on frailty status remains unclear ; therefore , we clarified the effect of a PA intervention with feedback , as an adjunct to resistance strength training , on the physical and mental outcomes of frail older adults . MATERIAL S AND METHODS We employed a r and omized controlled trial . Community-dwelling frail older adults in Japan were recruited to participate . Forty-one participants ( mean age 81.5 ) were r and omly assigned to engage in a resistance training with PA ( RPA group ) or RT group for six months . Frailty status and frailty scores , which were measured according to the Cardiovascular Health Study criteria -muscle strength , mobility , instrumental activities of daily living , and health-related quality of life-were assessed . RESULTS Participants in the RPA group exhibited a significant increase in light-intensity PA , the number of steps taken daily ( p < 0.05 ) , and lower-limb muscle strength ( p < 0.05 ) and a significant decrease in frailty scores . However , pre- and postintervention frailty status , instrumental activities of daily living , and health-related quality of life did not differ significantly . CONCLUSIONS Implementation of a PA intervention as an adjunct to RT is feasible , as it reduced frailty scores and increased lower-limb muscle strength and mobility in older adults with frailty symptoms Background Diabetes , a highly prevalent , chronic disease , is associated with increasing frailty and functional decline in older people , with concomitant personal , social , and public health implication s. We describe the rationale and methods of the multi-modal intervention in diabetes in frailty ( MID-Frail ) study . Methods / Design The MID-Frail study is an open , r and omised , multicentre study , with r and om allocation by clusters ( each trial site ) to a usual care group or an intervention group . A total of 1,718 subjects will be r and omised with each site enrolling on average 14 or 15 subjects . The primary objective of the study is to evaluate , in comparison with usual clinical practice , the effectiveness of a multi-modal intervention ( specific clinical targets , education , diet , and resistance training exercise )  in frail and pre-frail subjects aged ≥70 years with type 2 diabetes in terms of the difference in function 2 years post-r and omisation . Difference in function will be measured by changes in a summary ordinal score on the short physical performance battery ( SPPB ) of at least one point . Secondary outcomes include daily activities , economic evaluation , and quality of life . Discussion The MID-Frail study will provide evidence on the clinical , functional , social , and economic impact of a multi-modal approach in frail and pre-frail older people with type 2 diabetes . Trial registration Clinical Trials.gov : NCT01654341 ABSTRACT High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV , thus , they may reduce the risk of developing HIV-associated neurocognitive disorder ( H AND ) . This study aim ed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV . Eleven participants living with HIV were recruited into the study . Participants were r and omised into either an exercise group ( n = 5 ) , that completed a 16-week aerobic exercise programme training , 3 times per week ( 2 supervised sessions and one unsupervised session ) or a control group ( n = 6 ) that received no intervention . Outcomes measured included cognitive function ( Montreal cognitive assessment ( MOCA ) and the Trail making tests A and B ) , aerobic fitness ( modified Bruce protocol ) , sleep quality ( Pittsburgh sleep quality index ; PSQI ) and physical activity levels ( seven-day accelerometry ) . At baseline , higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores ( P = 0.04 and P = 0.001 respectively ) . However , exercise training did not induce any significant improvements in cognitive function or aerobic fitness . The overall mean adherence rate to the exercise programme was 60 % . In conclusion , in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV . It is likely that longer intervention periods and /or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments OBJECTIVES To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge . DESIGN Multicenter , r and omized , controlled trial with a factorial design . SETTING Five hospitals in Auckl and , New Zeal and , and Sydney , Australia . PARTICIPANTS Two hundred forty-three frail older people . INTERVENTIONS Patients were r and omized to receive a single dose of vitamin D ( calciferol , 300,000 IU ) or placebo tablets and 10 weeks of high-intensity home-based quadriceps resistance exercise or frequency-matched visits . MEASUREMENTS The primary endpoints were physical health according to the short-form health survey at 3 months and falls over 6 months . Physical performance and self-rated function were secondary endpoints . Assessment s took place in the participants ' homes at 3 and 6 months after r and omization and were performed by blinded assessors . RESULTS There was no effect of either intervention on physical health or falls , but patients in the exercise group were at increased risk of musculoskeletal injury ( risk ratio = 3.6 , 95 % confidence interval = 1.5 - 8.0 ) . Vitamin D supplementation did not improve physical performance , even in those who were vitamin D deficient ( < 12 ng/mL ) at baseline . CONCLUSION Neither vitamin D supplementation nor a home-based program of high-intensity quadriceps resistance exercise improved rehabilitation outcomes in frail older people after hospitalization . There was no effect of vitamin D on physical performance , and the exercises increased the risk of musculoskeletal injury . These findings do not support the routine use of these interventions at these dosages in the rehabilitation of frail older people
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 .