Reduces severity and progression of frailty
Physical exercise programs are generally effective for reducing or postponing frailty but only when conducted in groups. Favourable effects on frailty indicators are also observed after the interventions, based on physical exercise with hormone supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits are not universally effective. There is lack of efficacy for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy (10).
Exercise classes including a combination of moderate-intensity aerobic exercise, progressive strength training, flexibility and balance result in significant improvements in total scores of the frailty checklist compared to control groups (exercise group from 7.41 ±98 to 7.11 ± 4.00, control group from 7.34 ± 4.27 to 8.02 ± 4.81, P < 0.001). Individual components with significant improvement include forgetfulness, seclusion, emotion and daily domains, there is no significant difference in other domains (11).
Moderate physical activity at least once a week is associated with improved frailty progression in those aged 65 and over as well as those aged 50–54. A greater improvement in frailty progression occurs in adults who report vigorous physical activity at least once a week (12).
Quality of evidence
Strength of recommendation
Exercise is likely to reduce frailty severity and progression. The strongest evidence is for group based programmes which include aerobic, strength and balance training. Vigorous activity is probably more effective than moderate exercise in limiting frailty progression (strength, energy, mobility) but this may be unachievable in a large proportion of frailty patients.
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- 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.
- 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.
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- 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.
- 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.
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- 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.