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

Abstract

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 searched systematically for randomised controlled trials (RCTs) and cluster RCTs, with literature searching 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.

Keywords: Frailty; community; exercise; home-based; systematic review.

Conflict of interest statement

Conflict of interest

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) AC is principal investigator (PI) for the Home-based Older People's Exercise (HOPE) trial, a pilot randomised controlled trial to investigate the effects of an exercise intervention for frail older people, funded by the Dunhill Medical Trust; JY is head of the Academic Unit of Elderly Care and Rehabilitation, University of Leeds, which is the host institution for the HOPE trial SB, AF and SI declare that they have no conflicts of interest.

Figures

Figure 1

PRISMA flow diagram

Figure 2

Forest plot presenting individual and pooled risk of long-term care admission from two trials at low risk of methodological bias.