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Falls and Frailty – Improves functional ability

Improves functional ability

Evidence summary

Exercise showed positive results in reducing ADL disability in around 40% of studies. In the 10 studies that used basic ADL scales 50% showed positive effects, in the four studies that used instrumental ADL (IADL) scales only one improved IADL ability, and in the six studies that used both subscales only two reported significant improvements (7).

Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions results in reduced use of assistive devices for mobility, function, and safety compared with controls. Resistance training results in significantly less decline in basic ADL toileting and transferring scores compared to controls, with a similar trend for overall basic ADL score. IADL scores do not change differentially between groups over time (8).

Overall, group exercise interventions have a significant and beneficial effect on physical functioning immediately post-intervention compared to usual care or flexibility home control exercise programmes. However the benefits are lost within 12 weeks, once exercise ceases. Significant improvements are seen in muscle strength (n= 4, SMD 0.44 (CI 0.11 to 0.77)) moderate heterogeneity) and balance (n = 3 studies, SMD 0.33 (CI 0.08 to 0.57), low heterogeneity) only (9).

Quality of evidence

B

Strength of recommendation

1

Conclusion

Exercise seems to benefit the oldest-old most as well as those in long-term care facilities. It is more effective in the earlier stages of frailty. Longer interventions (>5 months) produce greater gains than shorter ones. Multi-component exercise programmes, three times per week are most likely to be effective. There is no evidence to suggest exercise is harmful in frail populations.

References

  1. Gillespie, Lesley D., et “Interventions for preventing falls in older people living in the      community.” Cochrane Database Syst Rev 9.11 (2012).
  2. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2016 Oct 4:bjsports-2016.
  3. Lee SH, Kim HS. Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta‐Analysis. Worldviews on Evidence‐Based Nursing. 2017 Feb 1;14(1):74-80.
  4. Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy. 2012 May 1;66(3):284-91.
  5. Fairhall N, Sherrington C, Clemson L, Cameron ID. Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis. Age and ageing. 2011 Jul 14;40(6):666-74.
  6. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj. 2013 Oct 29;347:f6234.
  7. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, Jones GR. The effectiveness of exercise interventions for the management of frailty: a systematic review. Journal of aging research. 2011.
  8. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, Grady JN, Perry TJ, Lloyd BD, Smith EU, Singh MA. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association. 2012 Jan 1;13(1):24-30.
  9. Frost R, Belk C, Jovicic A, Ricciardi F, Kharicha K, Gardner B, Iliffe S, Goodman C, Manthorpe J, Drennan VM, Walters K. Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC geriatrics. 2017 Dec;17(1):157.
  10. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D’avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI database of systematic reviews and implementation reports. 2018 Jan 1;16(1):140-232.
  11. Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. Journal of the American Medical Directors Association. 2012 Jul 1;13(6):507-11.
  12. Rogers NT, Marshall A, Roberts CH, Demakakos P, Steptoe A, Scholes S. Physical activity and trajectories of frailty among older adults: Evidence from the English Longitudinal Study of Ageing. PloS one. 2017 Feb 2;12(2):e0170878.
  13. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation research. 2013 Apr 1;16(2):105-14.

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