Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians The effects of whey protein with or without carbohydrates on resistance training adaptations The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. Physical activity combined with resistance training reduces symptoms of frailty in older adults: A randomized controlled trial. Once weekly combined resistance and cardiovascular training in healthy older men. Exercise training and nutritional supplementation for physical frailty in very elderly people. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. Neither load nor systemic hormones determine resistance training-mediated hypertrophy or strength gains in resistance-trained young men Whole body vibration for older persons: an open randomized, multicentre, parallel, clinical trial
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 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 This r and omized controlled trial examined the effects of multicomponent training on muscle power output , muscle mass , and muscle tissue attenuation ; the risk of falls ; and functional outcomes in frail nonagenarians . Twenty-four elderly ( 91.9 ± 4.1 years old ) were r and omized into intervention or control group . The intervention group performed a twice-weekly , 12-week multicomponent exercise program composed of muscle power training ( 8–10 repetitions , 40–60 % of the one-repetition maximum ) combined with balance and gait retraining .  Strength and power tests were performed on the upper and lower limbs . Gait velocity was assessed using the 5-m habitual gait and the time-up- and -go ( TUG ) tests with and without dual-task performance . Balance was assessed using the FICSIT-4 tests . The ability to rise from a chair test was assessed , and data on the incidence and risk of falls were assessed using question naires . Functional status was assessed before measurements with the Barthel Index . Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography . The intervention group showed significantly improved TUG with single and dual tasks , rise from a chair and balance performance ( P < 0.01 ) , and a reduced incidence of falls . In addition , the intervention group showed enhanced muscle power and strength ( P < 0.01 ) . Moreover , there were significant increases in the total and high-density muscle cross-sectional area in the intervention group . The control group significantly reduced strength and functional outcomes . Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population Background Nutrition intake in the context of a resistance training ( RT ) bout may affect body composition and muscle strength . However , the individual and combined effects of whey protein and carbohydrates on long-term resistance training adaptations are poorly understood . Methods A four-week preparatory RT period was conducted in previously untrained males to st and ardize the training background of the subjects . Thereafter , the subjects were r and omized into three groups : 30 g of whey proteins ( n = 22 ) , isocaloric carbohydrates ( maltodextrin , n = 21 ) , or protein + carbohydrates ( n = 25 ) . Within these groups , the subjects were further r and omized into two whole-body 12-week RT regimens aim ing either for muscle hypertrophy and maximal strength or muscle strength , hypertrophy and power . The post-exercise drink was always ingested immediately after the exercise bout , 2–3 times per week depending on the training period . Body composition ( by DXA ) , quadriceps femoris muscle cross-sectional area ( by panoramic ultrasound ) , maximal strength ( by dynamic and isometric leg press ) and serum lipids as basic markers of cardiovascular health , were analysed before and after the intervention . Results Twelve-week RT led to increased fat-free mass , muscle size and strength independent of post-exercise nutrient intake ( P < 0.05 ) . However , the whey protein group reduced more total and abdominal area fat when compared to the carbohydrate group independent of the type of RT ( P < 0.05 ) . Thus , a larger relative increase ( per kg bodyweight ) in fat-free mass was observed in the protein vs. carbohydrate group ( P < 0.05 ) without significant differences to the combined group . No systematic effects of the interventions were found for serum lipids . The RT type did not have an effect on the adaptations in response to different supplementation paradigms . Conclusions Post-exercise supplementation with whey proteins when compared to carbohydrates or combination of proteins and carbohydrates did not have a major effect on muscle size or strength when ingested two to three times a week . However , whey proteins may increase abdominal fat loss and relative fat-free mass adaptations in response to resistance training when compared to fast-acting carbohydrates This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty BACKGROUND Progressive resistance exercise training ( PRT ) has been shown to increase muscle strength and fat-free mass ( FFM ) in elderly persons . Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons . METHODS Ninety-one community-dwelling sedentary men and women , 78 years and older with physical frailty ( defined using st and ardized objective criteria ) were enrolled in a 9-month trial of exercise training ( ET ) . Physical frailty was defined as having 2 of the 3 following criteria : modified Physical Performance Test score between 18 and 32 , peak aerobic power between 10 and 18 ml/kg/min , or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living . Participants were r and omly assigned to either a control ( CTL ) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT . RESULTS After completion of PRT , ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension ( mean Delta + 5.3 + /- 13 ft/lb vs + 1.1 + /- 11 ft/lb , p = .05 ) , measured using isokinetic dynamometry . Total body FFM ( measured using dual energy x-ray absorptiometry ) increased in the ET group , but not in the CTL group ( mean Delta + 0.84 + /- 1.4 kg vs + 0.01 + /- 1.5 kg , p = .005 ) . Total , trunk , intra-abdominal , and subcutaneous fat mass ( measured using dual energy x-ray absorptiometry and (1)H-magnetic resonance imaging ) did not change in response to PRT . CONCLUSIONS Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail , community-dwelling elderly women and men . This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population 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 PURPOSE To compare the effects of the 16-wk training period ( 2 d.wk(-1 ) ) of resistance training alone ( S ) , endurance training alone ( E ) , or combined resistance ( once weekly ) and endurance ( once weekly ) training ( SE ) on muscle mass , maximal strength and power of the leg and arm extensor muscles , and maximal workload ( Wmax ) by using a incremental cycling test in older men . METHODS Thirty-one healthy men ( 65 - 74 yr ) were divided into three treatment groups to train 2x wk(-1 ) for 16 wk : S ( N = 10 ) , E ( N = 11 ) , or SE ( N = 10 ; 1x wk(-1 ) S + 1x wk(-1 ) E ) . The subjects were tested at 8-wk intervals ( i.e. , weeks 8 and 16 ) . RESULTS There were no significant differences between  S- and SE-induced muscle hypertrophy ( 11 % and 11 % ) and maximal strength ( 41 % and 38 % ) gains of the legs as well as between E- and SE-induced Wmax ( 28 % and 23 % ) gains . The increase in arm strength in S ( 36 % ) was greater than that recorded in SE ( 22 % ) and greater than that recorded in E ( 0 % ) . CONCLUSIONS Prolonged combined resistance and endurance training in older men seemed to lead to similar gains in muscle mass , maximal strength , and power of the legs as resistance training alone and to similar gains in maximal peak power output measured in an incremental cycling test as endurance training alone . These findings may have an effect on how resistance exercise is prescribed to older adults BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture We reported , using a unilateral resistance training ( RT ) model , that training with high or low loads ( mass per repetition ) result ed in similar muscle hypertrophy and strength improvements in RT-naïve subjects . Here we aim ed to determine whether the same was true in men with previous RT experience using a whole-body RT program and whether postexercise systemic hormone concentrations were related to changes in hypertrophy and strength . Forty-nine resistance-trained men ( 23 ± 1 yr , mean ± SE ) performed 12 wk of whole-body RT .  Subjects were r and omly allocated into a higher-repetition ( HR ) group who lifted loads of ∼30 - 50 % of their maximal strength ( 1RM ) for 20 - 25 repetitions/set ( n = 24 ) or a lower-repetition ( LR ) group ( ∼75 - 90 % 1RM , 8 - 12 repetitions/set , n = 25 ) , with all sets being performed to volitional failure . Skeletal muscle biopsies , strength testing , dual-energy X-ray absorptiometry scans , and acute changes in systemic hormone concentrations were examined pretraining and posttraining . In response to RT , 1RM strength increased for all exercises in both groups ( P < 0.01 ) , with only the change in bench press being significantly different between groups ( HR , 9 ± 1 , vs. LR , 14 ± 1 kg , P = 0.012 ) . Fat- and bone-free ( lean ) body mass and type I and type II muscle fiber cross-sectional area increased following training ( P < 0.01 ) with no significant differences between groups . No significant correlations between the acute postexercise rise in any purported anabolic hormone and the change in strength or hypertrophy were found . In congruence with our previous work , acute postexercise systemic hormonal rises are not related to or in any way indicative of RT-mediated gains in muscle mass or strength . Our data show that in resistance-trained individuals , load , when exercises are performed to volitional failure , does not dictate hypertrophy or , for the most part , strength gains 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 :
Conclusion Frequency of 1–6 sessions per week , training volume of 1–3 sets of 6–15 repetitions and intensity of 30–70%1-RM promoted significant enhancements on muscle strength , muscle power , and functional outcomes .
Therefore , in agreement with previous studies , we suggest that supervised and controlled RT represents an effective intervention in frailty treatment
Aim Exercise is one of the most important components in frailty prevention and treatment .
Therefore , we systematic ally review ed the effect of resistance training ( RT ) alone or combined with multimodal exercise intervention on muscle hypertrophy , maximal strength , power output , functional performance , and falls incidence in physically frail elderly .