Effectiveness of exercise interventions on the physical function, frailty status, daily living activities in community-dwelling pre-frail older adults: A systematic review and meta-analysis

Abstract

Background: Frailty, an emerging geriatric condition and a public health issue, is accompanied with adverse health outcomes, including lowered physical function. Many exercises have been developed for the frail elderly, but not their pre-frail counterparts. Currently, no systematic review and meta-analysis has regarded the effectiveness of exercises for the pre-frail elderly. Objectives: To assess the effectiveness of exercise interventions on the physical function, activities of daily living (ADL) and frailty status among community-dwelling pre-frail elderly. Selection Criteria: English-language randomized controlled trials (RCTs) or quasiexperimental trials (QETs) of exercises for community-dwelling pre-frail elderly aged 60 and above, with primary outcome (physical function), and/or secondary outcomes (ADL and frailty status improvement) were included. Methods: A three-step search was executed in eleven online databases for published and unpublished trials. CENTRAL, CINAHL, Embase, Google Scholar, MedLine, PEDro, ProQuest, PsycINFO, PubMed, Scopus and Web of Science were searched from inception to December 2020. Relevant trials were independently screened by two reviewers (AA and BB), followed by data extraction and methodological quality assessment, through risk of bias or ROBINS-I. Quality of evidence was done using GRADE. Meta-analyses were performed for the different outcomes. Results: 16 studies were included in the review, with 15 eligible for meta-analyses. Findings showed a large effect size on handgrip strength (d=2.05) and significant improvements in both gait speed (d=-0.21) and frailty status improvement post-intervention. However, insignificant effects were found in functional mobility, physical performance and ADL. Conclusion and Implications: Resistance exercises seem to improve some physical function components like handgrip strength and gait speed among pre-frail elderly. Adherence to exercises may be affected by how convenient they can be carried out and the intensity of interventions. Future research on specific exercise components for the pre-frail can be explored.