CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS … · Thirteen studies examined multi-component exercise interventions.1,3-5,7,10,12-14,18,21-22,24 Six studies did not specify

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Version: 1.0

Publication Date: May 25, 2018

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CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS

Exercise Interventions for the Delayed Progression or Reversal of Frailty

SUMMARY OF ABSTRACTS Exercise Interv entions f or the Delay ed Progression or Rev ersal of Frailty 2

Authors: Casey Gray, Charlene Argáez

Cite As: Exercise interv entions f or the delay ed progression or rev ersal of f railty : clinical effectiveness. Ottawa: CADTH; 2018 May . (CADTH rapid response

report: summary of abstracts).

Acknowledgments:

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Research Question

What is the effectiveness of exercise interventions to reverse or delay the progression of

frailty in those with frailty?

Key Findings

Ten systematic reviews (two with meta-analyses), ten randomized controlled trials, and four

non-randomized studies were identified regarding the effectiveness of exercise

interventions to reverse or delay the progression of frailty in those with frailty.

Methods

A limited literature search was conducted on key resources PubMed, The Cochrane

Library, University of York Centre for Reviews and Dissemination (CRD) databases,

Canadian and major international health technology agencies, as well as a focused Internet

search. No methodological filters were applied to limit retrieval by publication type. The

search was limited to English language documents published between January 1, 2011

and May 8, 2018. Internet links were provided, where available.

Selection Criteria

One reviewer screened citations and selected studies based on the inclusion criteria

presented in Table 1.

Table 1: Selection Criteria

Population Patients with frailty (living in the community, living in long term care, or in acute care)

Intervention Exercise interventions

Comparator Usual care

People who are getting what is currently normal in their setting

No prescribed change in what they are doing

Outcomes Effectiveness and clinical benefit at the patient level, patient centred outcomes. e.g.,

Quality of life improvements

Improvements on a frailty scale Improvements in functional status

Increased muscle strength or stamina

Healthcare utilization/need for interventions (need for trip to ER, length of stay)


Study Designs Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies

Results

Rapid Response reports are organized so that the higher quality evidence is presented first.

Therefore, health technology assessment reports, systematic reviews, and meta-analyses

are presented first. These are followed by randomized controlled trials, and non-

randomized studies.

Ten systematic reviews (two with meta-analyses), ten randomized controlled trials, and four

non-randomized studies were identified regarding the effectiveness of exercise

interventions to reverse or delay the progression of frailty in those with frailty. No relevant

health technology assessments were identified.

Additional references of potential interest are provided in the appendix.

Overall Summary of Findings

Ten systematic reviews,1-10 (two with meta-analyses),5,8 ten randomized controlled trials,11-

20 and four non-randomized studies21-24 were identified regarding exercise interventions for

frailty. Detailed study characteristics are provided in Table 2.

Thirteen studies examined multi-component exercise interventions.1,3-5,7,10,12-14,18,21-22,24 Six

studies did not specify the type(s) of exercise examined.2,8-9,11,16,23 Five studies examined a

single specific type of exercise: chair based exercise,6 interval-based inspiratory muscle

training with a device versus yoga breathing exercises,15 whole body vibration exercises,17

Tai Chi,19 and interactive videogame based dynamic balance exercises.20

Quality of Life Improvements

One systematic review3, one randomized study,13 and one non-randomized study22 showed

a beneficial effect of a multi-component exercise intervention on psychological wellbeing3

and Quality of Life.13,22

In studies that did not specify the type of exercise, there was no difference in quality of life

between intervention and comparator groups in one systematic review and one randomized

study, and findings were unclear in one systematic review.8,16,9

No studies examined a single exercise type with respect to quality of life.

Improvements on a frailty scale

One systematic review and one randomized study showed a positive effect of multi-

component exercise on frailty. 4,13

Frailty was reversed with unspecified exercise intervention in one randomized study.11

No studies examined a single exercise type with respect to frailty reversal.


Improvements in functional status

Three systematic reviews and one randomized study had improved physical

functioning/performance with exercise versus comparator.1,3,5,18 Two systematic reviews

and one randomized study reported improvements in falls incidence with exercise.4,7,14

Mobility was improved with exercise in one systematic review.4 Flexibility was improved with

exercise in one randomized study.12 Evidence was mixed for balance, with unclear findings

reported in two systematic reviews,4,5 and favourable results in one systematic review,7 one

randomized study,14 and one non-randomized study.22 Two randomized studies 12,13 and one

non-randomized study21 showed improved ability to rise from a chair in the exercise group

relative to a comparison group. Two systematic reviews5,7 and one randomized study14

showed a positive effect of exercise on gait velocity, and one non-randomized study

showed that exercise improved time to complete a 10 min walk. 21 There were mixed

findings for activities of daily living, with one SR showing unclear effects,5 and one non-

randomized study showing improvements with exercise intervention versus comparison

group.21 One RCT showed a positive effect of exercise on the swallowing related function of

voluntary peak cough flow, but no effect on lip closure force.12

Among studies that did not describe the type of exercise examined, systematic reviews

showed improved physical performance,2 balance,8 and gait speed8 with exercise versus a

comparator. One randomized studies showed improved speed and agility for the exercise

intervention group versus the comparator. Findings for activities of daily living and mobility

were mixed: activities of daily living were improved in one systematic review, but there was

no difference between groups in one randomized study.8,16 One systematic review reported

improved disability in older people with moderate, but not severe frailty.9 Finally, timed-up-

and-go test of mobility showed no difference between exercise and comparator in one

systematic review, however the authors of one randomized study reported non-significant,

yet clinically important mobility improvements with exercise.8,16

Four studies examined the effect of a single exercise type on functional status.6,15,17,19

Regarding chair-based exercises, most studies examined in a systematic review showed

that exercise improved mobility and function relative to a control group.6 In a randomized

study of older adults with frailty who were unable to perform whole body exercise, yoga

respiratory training improved maximum inspiratory and expiratory pressure and maximum

voluntary ventilation compared with an inspiratory muscle training group and a non-exercise

control group.15 Compared with usual care and exercises, frail older adults randomized to

perform whole body vibration exercises had improved mobility, leg strength and endurance,

activities-specific balance confidence score, and general health status.17 Finally, compared

with conventional physical therapy, adults with physical frailty randomized to participate in

Tai Chi had a greater improvement in falls.19

Increased muscle strength or stamina

Two systematic reviews, one randomized study, and one non-randomized study showed

improved muscle strength with multi-component exercise.1,7,12,22 Studies that examined

muscular endurance reported inconsistent findings, with one inconclusive systematic

review5 and one non-randomized study showing improved endurance with multi-component

exercise.22

A systematic review and a randomized study showed improved muscle strength with

exercise (type not specified).2,11 One study showed no difference between unspecified

exercise and no-exercise conditions for fatigue or physical endurance, however an exercise


+ behavior change enhancement group had greater improvements in physical endurance

than the other two conditions.23

One systematic review examined the effect of single type of exercise on muscle strength or

stamina. In this review, chair-based exercises led to improved cardiorespiratory fitness

relative to a control group in most included studies.6

Healthcare utilization/need for interventions

One randomized study showed a decreased number of visits to primary care 13 and one

non-randomized study showed fewer new Long Term Care insurance service requirement

certifications24 with exercise versus comparison.

When the type of exercise was not specified, one systematic review reported unclear

findings with respect to the effect of exercise on hospitalization rates and long term care

admission rates.9

A single type of exercise was examined in one randomized study. This study showed that

an interactive videogame based dynamic balance exercises group led to greater

improvements in balance than a conventional rehabilitation program, however there were

no differences between groups for dynamic standing balance control or gait.20

Table 2: Summary of Included Studies on Exercise Interventions for the Delayed

Progression or Reversal of Frailty

Author, Year Intervention (FITT)

Frequency, Intensity, Time, Type

Outcomes Results Author Conclusions

Systematic Reviews and Meta-Analyses

Liberman, 20171 F: NR I: NR T: NR T: resistance, aerobic, and “other” exercises

Muscle strength, physical functioning

Exercise had moderate- to large-beneficial effects on muscle strength and physical functioning

“Future studies should focus on the influence of specific exercise modalities and target the frail population more.”1

Lozano-Montoya, 20172

F:NR I:NR T:NR T:NR

Muscle strength, physical performance

Exercise improved muscle strength and physical performance

Exercise interventions improved physical performance in community-dwelling patients aged >65 years with physical frailty and sarcopenia Muscular strength was improved with multidisciplinary treatment and exercise interventions

Silva, 20173 F: ≥3 times / week I: NR T: Most interventions included ~60 min per session, over ≥ 6

Cognition, physical functioning, psychological wellbeing

Compared with the control group, exercise improved cognition, physical functioning, and psychological wellbeing

“Although exercise interventions appear to be effective in managing the various components of frailty and


Table 2: Summary of Included Studies on Exercise Interventions for the Delayed Progression or Reversal of Frailty




months T: Multicomponent exercises

preventing/delaying the onset of frailty, the most effective exercise program

in this population remains unidentified.”3

De Labra, 20154

F: NR I: NR T: NR T: Multicomponent aerobic or resistance exercises, physical comprehensiveness TR, strength TR

Falls, mobility, muscle strength, balance performance, change in frailty score

Compared with the control group, exercise improved falls, mobility, and frailty. The effect of exercise on balance was unclear. Effect sizes varied across studies

“This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program”.4

Gine-Garriga, 20145

F: NR I: NR T: NR T: multicomponent exercises

Physical performance scores, mobility, gait, ADL functional ability

Compared with the control group, exercise improved normal gait speed, fast gait speed, and physical performance scores. The effect of exercise on endurance, balance, and ADL functional mobility was not clear

“Exercise has some benefits in frail older people, although uncertainty still exists with regard to which exercise characteristics (type, frequency, duration) are most effective.”5

Anthony, 20136 F: NR I: NR T: NR T: Chair-based exercises

Mobility and function, cardiorespiratory fitness, and mental health

Compared with the control group, most studies showed that exercise improved mobility and function, cardiorespiratory fitness, and mental health.

There is low quality, inconclusive evidence about the effectiveness of chair-based exercises in this population. The literature is inconsistent about the definition and purpose of chair-based exercises.

Cadore, 20137 F:NR I: NR T: NR T: multicomponent exercise TR, resistance TR, endurance TR,

Incidence of falls, gait, balance, and lower-body strength

Compared with the control group, most studies showed the exercise reduced incidence of falls, and improved gait ability, balance, and muscle

“The multi-component exercise intervention composed by strength, endurance and balance training seems to be the best strategy to improve






balance TR strength rate of falls, gait ab ility, balance, and strength performance in physically

frail older adults.”7

Chou, 20128 F:NR I: NR T: NR T: single or multicomponent exercise

Physical function (TUGT, gait speed, balance, ADL), quality of life

Compared with the control group, the exercise group had improved gait speed, balance, and their performance in ADL. Groups did not differ for TUGT or QoL.

“Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults”.8

Clegg, 20129 F:NR I: NR T: NR T: home-based exercise

Mobility, QoL, ADL, long-term care admission, hospitalisation

Compared with the control group, the exercise group had improved disability in those with moderate but not severe frailty. The evidence was not clear for QoL, long-term care admission rates, hospitalization,

“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.”9

Theou, 201110 F:various frequencies I: various intensities T: various durations T: various types including multi-component; “Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults.”10

Various physical determinants of frailty; various functional outcomes

NR “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.”10

“Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults.”10

Randomized Controlled Trials

Ferreira, 201811 F: NR I: NR T: 12 weeks; session duration NR T: NR

Muscle strength, speed, agility

Compared with the control group, the exercise group had improved muscle strength, speed, agility, and reversed frailty

“The 12-week exercise program for frail elderly residents in a long-term care facility was efficient in improving muscle strength, speed, agility..”11






Takatori, 201612 F: 3 times / week I: NR T: 6 months; “brief” session duration T: multi-component: home-based exercises targeting prevention of aspiration pneumonia and falls

Prevention of aspiration pneumonia: Voluntary peak cough flow, lip closure force Falls prevention: physical function (TUGT, chair stand, maximal knee extension strength, sit and reach)

Prevention of aspiration pneumonia: Compared with the control group, the exercise group had greater voluntary peak cough flow and did not differ for lip closure force Falls prevention: Compared with the control group, the exercise group had greater improvement in TUGT, Chair Stand Test, maximal knee extension strength, and Sit and Reach Test

“Specifically developed home-based exercise as described in this study is

simple and can be performed briefly. Improvements in voluntary peak cough flow and physical function indicate the possib le usefulness of such exercise in preventing falls and aspiration pneumonia in community-dwelling frail older adults.”12

Tarazona-Santabalbina, 201613

F: 5 days / week I: NR T: 24 weeks; 65 ,min per session T: supervised-facility multicomponent exercise program consisting of proprioception, aerobic, strength, and stretching exercises

Frailty, functionality, cognitive impairment, depression, biological biomarkers of frailty

Compared with the control group, the exercise group reversed frailty and improved functional measurements of frailty, cognitive impairment, depression, QoL, and decreased the number of visits to primary care physician

“We have designed a multicomponent exercise intervention that reverses frailty and improves cognition, emotional, and social networking in a controlled population of community-dwelling frail older adults.”13

Cadore, 201414 F: 2 times / week I: 40% - 60% of 1-repetition maximum T: 12 weeks; T: Multicomponent (muscle power TR, balance, gait retraining

Gait velocity, balance, ability to rise from a chair, incidence and risk of falls, functional status

Compared with the control group who experienced reduced strength and functional outcomes over the course of the study, the exercise group improved gait velocity, balance, ability to rise from a chair, and had a reduced incidence of falls.

“Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population.”14

Cebria, 201415 F: 5 days / week I: NR T: 6 weeks T: 1) supervised, interval-based inspiratory muscle TR device or

Respiratory muscle strength (maximum inspiratory pressure, maximum expiratory pressure) and respiratory muscle endurance (maximum

Compared with interval based inspiratory muscle TR and the control group, the yoga intervention group had improved maximum inspiratory and expiratory pressure, and maximum

Yoga respiratory training was effective and well-tolerated in frail older adults, and may therefore be a useful alternative to inspiratory threshold TR or no training, to improve






2) yoga breathing exercises

voluntary ventilation) voluntary ventilation. respiratory muscle when whole body exercise TR is not possible.

Clegg, 201416 F: NR I: NR T:12 weeks T: NR

Mobility, measured using the TUGT. Secondary outcomes were ADL, health-related QoL and depression.

Compared with the control group, the exercise group had a non-significant clinically important improvement in TUGT test. There were no differences in ADL, or health-related QoL

The Home-based Older People's Exercise trial pilot study reduced the deterioration in mobility among older people with frailty.

Zhang, 201417 F: 3-5 times / week I: NR T: 8 weeks; 4-5 min per session T: whole body vibration exercises

TUGT (mobility), leg strength and endurance, lower extremities muscle strength, balance function, balance confidence and General Health Status

Compared with usual care and exercises, the whole body vibration exercise group had improved mobility, leg strength and endurance, bilateral knees extensor strength, activities-specific balance confidence score and general health status There were no side-effects observed during the TR

“Whole-body vibration exercise is a safe and effective method that can improve the mobility, knee extensor strength, balance and the general health status in the frail elderly.”17

Gine-Garriga, 201318

F: NR I: NR T: 12 weeks T: Functional circuit training (functional balance and lower-body strength-based exercises)

Self-reported physical function, fear of falling (activities specific balance confidence), physical composite score, mental composite score

Compared with the control group, the exercise group had greater improvements in fear of falling, self-reported physical function, physical composite score and mental composite score at post-test and 36 week follow-up.

“These data indicate that a FCT program is effective in improving self-reported measures of fear of falling

and health status in a group of physically frail individuals.”18

Tousignant, 201319

F: NR I: light-moderate intensity T: 15 weeks T: Tai Chi

Fall incidence and severity

Compared with conventional physical therapy, the Tai Chi group had a greater improvement in falls.

“Supervised Tai Chi exercises as part of a rehabilitation program seem to be a more effective alternative to the conventional physical therapy exercises for this specific population.”19

Szturmm 201120

F: 2 times / week I: NR T: 8 weeks; 45 min / session T: interactive

Balance, TUGT (dynamic standing balance control), activities-specific balance confidence,

Compared with a conventional rehabilitation program, the intervention group had greater improvements in balance

“Dynamic balance exercises on fixed and compliant sponge surfaces were feasib ly coupled to interactive game-based






videogame-based dynamic balance exercises

sensory interaction and balance, and spatiotemporal gait variables

performance scores There were no differences between groups for TUGT or spatiotemporal gait variables

exercise. This coupling, in turn, resulted in a greater improvement in dynamic

standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.”20

Non-Randomized Studies

Kato, 201821 F: 7 days / week I: low to moderate T: 12 weeks; 20 min / session T: Marching in place and chair rising movements; gradually increasing speed of movements

ADL, mean power during chair stand, and time to complete a 10-m walk

Compared with the no-exercise comparison group, the exercise group had greater improvements in ADL, mean and relative power during chair stand, and 10-M walk

“The progressive marching in place and chair rising exercise intervention appears to be effective in improving activities of daily living and functional mobility among frail older adults.”21

Hong, 201722 F: 2 times / week I: NR T: 8 weeks T: A community capacity building exercise maintenance program

Muscular strength, static balance, muscular endurance, and health related QoL.

Compared with the physical exercise program comparator, the intervention group had greater improvements in muscular strength, static balance, muscular endurance, and health-related quality of life.

“Results indicated that a community capacity building exercise maintenance program is feasib le, and associated with exercise maintenance among frail elderly women.”22

Liu, 201723 F: NR I: NR T: 16 weeks T: Exercise + behavior change enhancement; Exercise + health talks

Fatigue, physical endurance

Combined (exercise + behavior change enhancement); exercise (exercise + health talks); and comparison (health talks alone) groups did not differ for fatigue. “A trend of greater improvement in physical endurance was observed in the combined group than in the other two groups.”23

Not relevant to current research question.

Yamada, 201724 F: 1 or 2 times/week I: light T: Unclear number of years; 60 min / session T: group-based self-

new Long Term Care Insurance service requirement certifications (indicator for health

Compared with the control group, the self-management exercise group had fewer new Long Term Care Insurance service

“These results indicate the usefulness of self-management group exercise to reduce the incidence of disability in






management multi-component exercise (aerobic, strength TR, flexibility and balance)

services use) requirement certifications during the 4 years of the study.

older adults. Thus, increasing self-management group

activities in each community should be encouraged.”24

References Summarized

Health Technology Assessments

No literature identified.

Systematic Reviews and Meta-analyses

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This randomized controlled trial examined the effects of multicomponent training

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Non-Randomized Studies

Marching and Chair Rising

21. Kato Y, Islam MM, Koizumi D, Rogers ME, Takeshima N. Effects of a 12-week

marching in place and chair rise daily exercise intervention on ADL and functional

mobility in frail older adults. J Phys Ther Sci. 2018 Apr;30(4):549-554.

PubMed: PM29706704

Type Not Specified

22. Hong SY, Jun SY. Community capacity building exercise maintenance program for frail

elderly women. Asian Nurs Res. 2017 Sep;11(3):166-173.

PubMed: PM28991596











23. Liu JY, Lai CK, Siu PM, Kwong E, Tse MM. An individualized exercise programme with

and without behavioural change enhancement strategies for managing fatigue among

frail older people: a quasi-experimental pilot study. Clin Rehabil. 2017 Apr;31(4):521-

531.

PubMed: PM27162189

Multi-Component

24. Yamada M, Arai H. Self-management group exercise extends healthy life expectancy

in frail community-dwelling older adults. Int J Environ Res Public Health. 2017 May

15;14(5).

PubMed: PM28505140




Appendix — Further Information

Systematic Reviews – Mixed Population

Frail and Pre-Frail

25. Jadczak AD, Makwana N, Luscombe-Marsh N, Visvanathan R, Schultz TJ.

Effectiveness of exercise interventions on physical function in community-dwelling frail

older people: an umbrella review of systematic reviews. JBI Database System Rev

Implement Rep. 2018 Mar;16(3):752-775.

PubMed: PM29521871

Systematic Review – Mixed Intervention

26. Dedeyne L, Deschodt M, Verschueren S, Tournoy J, Gielen E. Effects of multi -domain

interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic

review. Clin Interv Aging. 2017;12:873-896.

PubMed: PM28579766

Review Articles – Systematic Methods Not Specified

27. Marzetti E, Calvani R, Tosato M, Cesari M, Di Bari M, Cherubini A, et al. Physical

activity and exercise as countermeasures to physical frailty and sarcopenia. Aging Clin

Exp Res. 2017 Feb;29(1):35-42.

PubMed: PM28181204

28. Izquierdo M, Cadore EL. Muscle power training in the institutionalized frail: a new

approach to counteracting functional declines and very late-life disability. Curr Med Res

Opin. 2014 Jul;30(7):1385-90.

PubMed: PM24666003

Randomized Controlled Trial – Mixed Intervention

29. Haider S, Dorner TE, Luger E, Kapan A, Titze S, Lackinger C, et al. Impact of a home-

based physical and nutritional intervention program conducted by lay-volunteers on

handgrip strength in prefrail and frail older adults: a randomized control trial. PloS One.

2017;12(1):e0169613.

PubMed: PM28085913

30. Walters K, Frost R, Kharicha K, et al. Home-based health promotion for older people

with mild frailty: the HomeHealth intervention development and feasibility RCT. Health

Technol Assess [Internet]. 2017;

https://www.journalslibrary.nihr.ac.uk/hta/hta21730/#/abstract

Accessed May 24, 2018

31. Kim H, Suzuki T, Kim M, Kojima N, Ota N, Shimotoyodome A, et al. Effects of exercis e

and milk fat globule membrane (mfgm) supplementation on body composition, physical

function, and hematological parameters in community-dwelling frail japanese women: a

randomized double blind, placebo-controlled, follow-up trial. PloS One.

2015;10(2):e0116256.






https://www.journalslibrary.nihr.ac.uk/hta/hta21730/#/abstract


PubMed: PM25659147

Randomized Controlled Trials – Mixed/Co-Morbid Population

Frail and Pre-Frail

32. Danilovich MK, Conroy DE, Hornby TG. Feasibility and impact of high-intensity walking

training in frail older adults. J Aging Phys Act. 2017 Oct 1;25(4):533-538.

PubMed: PM28120633

33. Ozaki K, Kondo I, Hirano S, Kagaya H, Saitoh E, Osawa A, et al. Training with a

balance exercise assist robot is more effective than conventional training for frail older

adults. Geriatr Gerontol Int. 2017 Nov;17(11):1982-1990.

PubMed: PM28295912

34. Seino S, Nishi M, Murayama H, Narita M, Yokoyama Y, Nofuji Y, et al. Effects of a

multifactorial intervention comprising resistance exercise, nutritional and psychosocial

programs on frailty and functional health in comm unity-dwelling older adults: A

randomized, controlled, cross-over trial. Geriatr Gerontol Int. 2017 Nov;17(11):2034-

2045.

PubMed: PM28393440

35. Ng TP, Feng L, Nyunt MS, Feng L, Niti M, Tan BY, et al. Nutritional, physical, cognitive,

and combination interventions and frailty reversal among older adults: a randomized

controlled trial. Am J Med. 2015 Nov;128(11):1225-1236.e1.

PubMed: PM26159634

36. Tieland M, Verdijk LB, de Groot LC, van Loon LJ. Handgrip strength does not

represent an appropriate measure to evaluate changes in muscle strength during an

exercise intervention program in frail older people. Int J Sport Nutr Exerc Metab . 2015

Feb;25(1):27-36.

PubMed: PM24903908

37. van de Rest O, van der Zwaluw NL, Tieland M, Adam JJ, Hiddink GJ, van Loon LJ, et

al. Effect of resistance-type exercise training with or without protein supplementation

on cognitive functioning in frail and pre-frail elderly: secondary analysis of a

randomized, double-blind, placebo-controlled trial. Mech Ageing Dev. 2014 Mar-

Apr;136-137:85-93.

PubMed: PM24374288

38. Langlois F, Vu TT, Chasse K, Dupuis G, Kergoat MJ, Bherer L. Benefits of physical

exercise training on cognition and quality of life in frail older adults. J Gerontol B

Psychol Sci Soc Sci. 2013 May;68(3):400-4.

PubMed: PM22929394

Frail with Chronic Obstructive Pulmonary Disease










39. Torres-Sanchez I, Valenza MC, Cabrera-Martos I, Lopez-Torres I, Benitez-Feliponi A,

Conde-Valero A. Effects of an exercise intervention in frail older patients with chronic

obstructive pulmonary disease hospitalized due to an exacerbation: a randomized

controlled trial. COPD. 2017 Feb;14(1):37-42.

PubMed: PM27715322

Frail with Dementia

40. Cadore EL, Moneo AB, Mensat MM, Munoz AR, Casas -Herrero A, Rodriguez-Manas

L, et al. Positive effects of resistance training in frail elderly patients with dementia after

long-term physical restraint. Age (Dordrecht, Netherlands). 2014 Apr;36(2):801-11.

PubMed: PM24243397

Randomized Controlled Trial – Other Population

Frailty Not Specified

41. Cesari M, Vellas B, Hsu FC, Newman AB, Doss H, King AC, et al. A physical activity

intervention to treat the frailty syndrome in older persons -results from the life-p study. J

Gerontol A Biol Sci Med Sci. 2015 Feb;70(2):216-22.

PubMed: PM25387728

Non-Randomized Studies – Mixed Population

Frail and Pre-Frail

42. Haider S, Luger E, Kapan A, Titze S, Lackinger C, Schindler KE, et al. Associations

between daily physical activity, handgrip strength, muscle mass, physical performance

and quality of life in prefrail and frail community-dwelling older adults. Qual Life Res.

2016 Dec;25(12):3129-3138.

PubMed: PM27363692

43. Ikeda T, Aizawa J, Nagasawa H, Gomi I, Kugota H, Nanjo K, et al. Effects and

feasibility of exercise therapy combined with branched-chain amino acid

supplementation on muscle strengthening in frail and pre-frail elderly people requiring

long-term care: a crossover trial. Appl Physiol Nutr Metab . 2016 Apr;41(4):438-45.

PubMed: PM26963483

44. Mohler MJ, Wendel CS, Taylor-Piliae RE, Toosizadeh N, Najafi B. Motor performance

and physical activity as predictors of prospective falls in community-dwelling older

adults by frailty level: application of wearable technology. Gerontol. 2016;62(6):654-

664.

PubMed: PM27160666

45. Tikkanen P, Lonnroos E, Sipila S, Nykanen I, Sulkava R, Hartikainen S. Effects of

comprehensive geriatric assessment-based individually targeted interventions on

mobility of pre-frail and frail community-dwelling older people. Geriatr Gerontol Int.

2015 Jan;15(1):80-8.

PubMed: PM24397847









Non-Randomized Studies – Other Population

General Population

46. Savela SL, Koistinen P, Stenholm S, Tilvis RS, Strandberg AY, Pitkala KH, et al.

Leisure-time physical activity in midlife is related to old age frailty. J Gerontol A Biol Sci

Med Sci. 2013 Nov;68(11):1433-8.

PubMed: PM23525478

Non-Randomized Studies – Mixed Intervention

Physical and Social Activity

47. McNamara B, Rosenwax L, Lee EA, Same A. Evaluation of a healthy ageing

intervention for frail older people living in the community. Australas J Ageing. 2016

Mar;35(1):30-5.

PubMed: PM25472546



Documents

CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS … · Thirteen studies examined multi-component exercise interventions.1,3-5,7,10,12-14,18,21-22,24 Six studies did not specify