Skip to main content
Erschienen in:

01.10.2016 | Beiträge zum Themenschwerpunkt

Frailty and exercise interventions

Evidence and barriers for exercise programs

verfasst von: PD Dr. E. Freiberger, W. Kemmler, M. Siegrist, C. Sieber

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 7/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Due to the worldwide demographic transition healthcare systems are facing new demands and are increasingly confronted with an older population with specific medical needs related to multiple chronic disorders. The majority of older persons have an increased risk of frailty. In addition to pharmaceutical interventions another beneficial approach for counteracting frailty might be exercise or physical activity intervention.

Objective

The first goal was to narratively investigate the state of the art effective exercise interventions for frail older persons and briefly discuss the importance of exercise intervention for frailty. The second goal was to give recommendations to overcome barriers in the recruitment process and how to increase adherence of frail older persons in exercise programs.

Results

Several systematic reviews came to the same conclusion that exercise has beneficial effects in frail older persons although uncertainty exists on the optimal exercise program with regard to frequency, type of exercise and duration. Furthermore, all reviews demonstrated the superior nature of multicomponent exercise programs as opposed to single component exercise programs. With regard to barriers different levels have to be taken into account and addressed: older persons themselves with self-efficacy and attitudes, the healthcare personnel involved and the provider of the intervention program.

Conclusion

Exercise seems a promising approach to counteract frailty but including frail older persons in research programs is challenging. Researchers have to be aware of the different levels of possible barriers ranging from older frail persons and medical personnel to researchers.
Literatur
1.
Zurück zum Zitat Turner G, Clegg A (2014) Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 43(6):744–747PubMedCrossRef Turner G, Clegg A (2014) Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 43(6):744–747PubMedCrossRef
2.
Zurück zum Zitat Cesari M (2011) The multidimensionality of frailty: Many faces of one single dice. J Nutr Health Aging 15(8):663–664PubMedCrossRef Cesari M (2011) The multidimensionality of frailty: Many faces of one single dice. J Nutr Health Aging 15(8):663–664PubMedCrossRef
3.
Zurück zum Zitat Cesari M, Canevelli M (2014) Horse-racing effect and clinical trials in older persons. Front Aging Neurosci 6:175PubMedPubMedCentral Cesari M, Canevelli M (2014) Horse-racing effect and clinical trials in older persons. Front Aging Neurosci 6:175PubMedPubMedCentral
4.
Zurück zum Zitat Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762PubMedCrossRef Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762PubMedCrossRef
5.
Zurück zum Zitat Gill TM, Gahbauer EA, Allore HG, Han L (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166(4):418–423PubMedCrossRef Gill TM, Gahbauer EA, Allore HG, Han L (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166(4):418–423PubMedCrossRef
6.
Zurück zum Zitat Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM (2010) Towards an integral conceptual model of frailty. J Nutr Health Aging 14(3):175–181PubMedCrossRef Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM (2010) Towards an integral conceptual model of frailty. J Nutr Health Aging 14(3):175–181PubMedCrossRef
7.
Zurück zum Zitat Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL et al (2016) Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 26:53–61PubMedCrossRef Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL et al (2016) Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 26:53–61PubMedCrossRef
8.
Zurück zum Zitat Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008) The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12(1):29–37PubMedCrossRef Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008) The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12(1):29–37PubMedCrossRef
9.
Zurück zum Zitat Caspersen CJ, Powell K, Christenson GM (1985) Physical activity, exercise, and physical fitness: Definitions and distinctions of health-related research. Public Health Rep 100(2):126–131PubMedPubMedCentral Caspersen CJ, Powell K, Christenson GM (1985) Physical activity, exercise, and physical fitness: Definitions and distinctions of health-related research. Public Health Rep 100(2):126–131PubMedPubMedCentral
10.
Zurück zum Zitat Montero-Fernandez N, Serra-Rexach JA (2013) Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 49(1):131–143PubMed Montero-Fernandez N, Serra-Rexach JA (2013) Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 49(1):131–143PubMed
11.
Zurück zum Zitat Goisser S, Kemmler W, Porzel S, Volkert D, Sieber CC, Bollheimer LC et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons – a narrative review. Clin Interv Aging 10:1267–1282PubMedPubMedCentral Goisser S, Kemmler W, Porzel S, Volkert D, Sieber CC, Bollheimer LC et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons – a narrative review. Clin Interv Aging 10:1267–1282PubMedPubMedCentral
12.
Zurück zum Zitat Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ et al (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41(7):1510–1530PubMedCrossRef Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ et al (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41(7):1510–1530PubMedCrossRef
13.
Zurück zum Zitat Tudor-Locke C, Craig C, Aoyagi Y, Bell R, Croteau K, De Bourdeaudhuij I et al (2011) How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 8(1):80PubMedPubMedCentralCrossRef Tudor-Locke C, Craig C, Aoyagi Y, Bell R, Croteau K, De Bourdeaudhuij I et al (2011) How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 8(1):80PubMedPubMedCentralCrossRef
14.
Zurück zum Zitat Chin A, Paw MJM, van Uffelen JGZ, Riphagen I, van Mechelen W (2008) The functional effects of physical exercise training in frail older people: A systematic review. Sports Med 38(9):781–793CrossRef Chin A, Paw MJM, van Uffelen JGZ, Riphagen I, van Mechelen W (2008) The functional effects of physical exercise training in frail older people: A systematic review. Sports Med 38(9):781–793CrossRef
15.
Zurück zum Zitat Daniels R, van Rossum E, de Witte L, Kempen G, van den Heuvel W (2008) Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 8(1):278PubMedPubMedCentralCrossRef Daniels R, van Rossum E, de Witte L, Kempen G, van den Heuvel W (2008) Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 8(1):278PubMedPubMedCentralCrossRef
16.
Zurück zum Zitat Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA et al (2011) The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011:1–19. doi:10.4061/2011/569194 CrossRef Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA et al (2011) The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011:1–19. doi:10.​4061/​2011/​569194 CrossRef
17.
Zurück zum Zitat Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M (2013) Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 16(2):105–114PubMedPubMedCentralCrossRef Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M (2013) Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 16(2):105–114PubMedPubMedCentralCrossRef
18.
Zurück zum Zitat de Vries NM, van Ravensberg CD, Hobbelen JSM, Olde Rikkert MGM, Staal JB, Nijhuis-van der Sanden MWG (2012) Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Res Rev 11(1):136–149PubMedCrossRef de Vries NM, van Ravensberg CD, Hobbelen JSM, Olde Rikkert MGM, Staal JB, Nijhuis-van der Sanden MWG (2012) Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Res Rev 11(1):136–149PubMedCrossRef
19.
Zurück zum Zitat Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A (2014) Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis. Arch Phys Med Rehabil 95(4):753–769PubMedCrossRef Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A (2014) Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis. Arch Phys Med Rehabil 95(4):753–769PubMedCrossRef
20.
Zurück zum Zitat de Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millan-Calenti JC (2015) Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 15:154PubMedPubMedCentralCrossRef de Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millan-Calenti JC (2015) Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 15:154PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Chou C‑H, Hwang C‑L, Wu Y‑T (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Arch Phys Med Rehabil 93(2):237–244PubMedCrossRef Chou C‑H, Hwang C‑L, Wu Y‑T (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Arch Phys Med Rehabil 93(2):237–244PubMedCrossRef
22.
Zurück zum Zitat Pedersen BK, Saltin B (2015) Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 25(Suppl 3):1–72PubMedCrossRef Pedersen BK, Saltin B (2015) Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 25(Suppl 3):1–72PubMedCrossRef
23.
Zurück zum Zitat Harris R, Dyson E (2001) Recruitment of frail older people to research: lessons learnt through experience. J Adv Nurs 36(5):643–651PubMedCrossRef Harris R, Dyson E (2001) Recruitment of frail older people to research: lessons learnt through experience. J Adv Nurs 36(5):643–651PubMedCrossRef
24.
Zurück zum Zitat Knechel NA (2013) The challenges of enrolling older adults into intervention studies. Yale J Biol Med 86(1):41–47PubMedPubMedCentral Knechel NA (2013) The challenges of enrolling older adults into intervention studies. Yale J Biol Med 86(1):41–47PubMedPubMedCentral
25.
Zurück zum Zitat Ridda I, Lindley R, MacIntyre RC (2008) The challenges of clinical trials in the exclusion zone: The case of the frail elderly. Australas J Ageing 27(2):61–66PubMedCrossRef Ridda I, Lindley R, MacIntyre RC (2008) The challenges of clinical trials in the exclusion zone: The case of the frail elderly. Australas J Ageing 27(2):61–66PubMedCrossRef
26.
Zurück zum Zitat Ross S, Grant A, Counsell C, Gillespie W, Russell I, Prescott R (1999) Barriers to participation in randomised controlled trials: A systematic review. J Clin Epidemiol 52(12):1143–1156PubMedCrossRef Ross S, Grant A, Counsell C, Gillespie W, Russell I, Prescott R (1999) Barriers to participation in randomised controlled trials: A systematic review. J Clin Epidemiol 52(12):1143–1156PubMedCrossRef
27.
Zurück zum Zitat Campbell MK, Snowdon C, Francis D, Elbourne D, McDonald AM, Knight R et al (2007) Recruitment to randomised trials: strategies for trial enrollment and participation study. The STEPS study. Health Technol Assess 11(48):iii–105CrossRef Campbell MK, Snowdon C, Francis D, Elbourne D, McDonald AM, Knight R et al (2007) Recruitment to randomised trials: strategies for trial enrollment and participation study. The STEPS study. Health Technol Assess 11(48):iii–105CrossRef
28.
Zurück zum Zitat Ridda I, MacIntyre CR, Lindley RI, Tan TC (2010) Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions. Vaccine 28(4):901–906PubMedCrossRef Ridda I, MacIntyre CR, Lindley RI, Tan TC (2010) Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions. Vaccine 28(4):901–906PubMedCrossRef
29.
Zurück zum Zitat Yardley L, Beyer N, Hauer K, McKee K, Ballinger C, Todd C (2007) 2007 Recommendations for promoting the engagement of older people in activities to prevent falls. Qual Saf Health Care 16(3):230–234PubMedPubMedCentralCrossRef Yardley L, Beyer N, Hauer K, McKee K, Ballinger C, Todd C (2007) 2007 Recommendations for promoting the engagement of older people in activities to prevent falls. Qual Saf Health Care 16(3):230–234PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Yardley L, Donovan-Hall M, Francis K, Todd C (2007) Attitudes and beliefs that predict older people’s intention to undertake strength and balance training. J Gerontol B Psychol Sci Soc Sci 62(2):P119–P125PubMedCrossRef Yardley L, Donovan-Hall M, Francis K, Todd C (2007) Attitudes and beliefs that predict older people’s intention to undertake strength and balance training. J Gerontol B Psychol Sci Soc Sci 62(2):P119–P125PubMedCrossRef
31.
Zurück zum Zitat Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C (2014) Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 54(4):599–610PubMedCrossRef Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C (2014) Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 54(4):599–610PubMedCrossRef
32.
Zurück zum Zitat Freiberger E, Vreede P (2011) Falls recall-limitations of the most used inclusion criteria. Eur Rev Aging Phys Act 8(7):105–108CrossRef Freiberger E, Vreede P (2011) Falls recall-limitations of the most used inclusion criteria. Eur Rev Aging Phys Act 8(7):105–108CrossRef
33.
Zurück zum Zitat Kemmler W, von Stengel S, Weineck J, Lauber D, Kalender W, Engelke K (2005) Exercise effects on menopausal risk factors of early postmenopausal women: 3‑yr Erlangen fitness osteoporosis prevention study results. Med Sci Sports Exerc 37(2):194–203PubMedCrossRef Kemmler W, von Stengel S, Weineck J, Lauber D, Kalender W, Engelke K (2005) Exercise effects on menopausal risk factors of early postmenopausal women: 3‑yr Erlangen fitness osteoporosis prevention study results. Med Sci Sports Exerc 37(2):194–203PubMedCrossRef
34.
Zurück zum Zitat Provencher V, Mortenson WB, Tanguay-Garneau L, Belanger K, Dagenais M (2014) Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: a systematic review. Arch Gerontol Geriatr 59(1):18–24PubMedCrossRef Provencher V, Mortenson WB, Tanguay-Garneau L, Belanger K, Dagenais M (2014) Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: a systematic review. Arch Gerontol Geriatr 59(1):18–24PubMedCrossRef
35.
Zurück zum Zitat Tinetti E, Powell L (1993) Fear of falling and self-efficacy: a cause of dependence in elderly persons. J Gerontol 48(special):35–38PubMedCrossRef Tinetti E, Powell L (1993) Fear of falling and self-efficacy: a cause of dependence in elderly persons. J Gerontol 48(special):35–38PubMedCrossRef
36.
Zurück zum Zitat Rochat S, Bula CJ, Martin E, Seematter-Bagnoud L, Karmaniola A, Aminian K et al (2010) What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years? Arch Phys Med Rehabil 91(6):879–884PubMedCrossRef Rochat S, Bula CJ, Martin E, Seematter-Bagnoud L, Karmaniola A, Aminian K et al (2010) What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years? Arch Phys Med Rehabil 91(6):879–884PubMedCrossRef
37.
Zurück zum Zitat Malini FM, Lourenco RA, Lopes CS (2016) Prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors: The Frailty in Brazilian Older People-Rio de Janeiro Study. Geriatr Gerontol Int 16(3):336–344PubMedCrossRef Malini FM, Lourenco RA, Lopes CS (2016) Prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors: The Frailty in Brazilian Older People-Rio de Janeiro Study. Geriatr Gerontol Int 16(3):336–344PubMedCrossRef
38.
Zurück zum Zitat Freiberger E, Blank WA, Salb J, Geilhof B, Hentschke C, Landendoerfer P, Halle M, Siegrist M (2013) Physiological and psychological effects of a multi-modal intervention on fall risk: A cluster randomized controlled trial in the general practitioner setting [PreFalls NCT01032252]. Clin Interv Aging 8:1079–1108PubMedPubMedCentralCrossRef Freiberger E, Blank WA, Salb J, Geilhof B, Hentschke C, Landendoerfer P, Halle M, Siegrist M (2013) Physiological and psychological effects of a multi-modal intervention on fall risk: A cluster randomized controlled trial in the general practitioner setting [PreFalls NCT01032252]. Clin Interv Aging 8:1079–1108PubMedPubMedCentralCrossRef
39.
Zurück zum Zitat Phillips EM, Katula J, Miller ME, Walkup MP, Brach JS, King AC et al (2010) Interruption of physical activity because of illness in the Lifestyle Interventions and Independence for Elders Pilot trial. J Aging Phys Act 18(1):61–74PubMedPubMedCentralCrossRef Phillips EM, Katula J, Miller ME, Walkup MP, Brach JS, King AC et al (2010) Interruption of physical activity because of illness in the Lifestyle Interventions and Independence for Elders Pilot trial. J Aging Phys Act 18(1):61–74PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Bleijenberg N, Ten Dam VH, Steunenberg B, Drubbel I, Numans ME, De Wit NJ et al (2013) Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study. J Adv Nurs 69(10):2262–2273PubMedCrossRef Bleijenberg N, Ten Dam VH, Steunenberg B, Drubbel I, Numans ME, De Wit NJ et al (2013) Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study. J Adv Nurs 69(10):2262–2273PubMedCrossRef
41.
Zurück zum Zitat Drey M, Zech A, Freiberger E, Bertsch T, Uter W, Sieber CC et al (2011) Effects of strength training versus power training on physical performance in prefrail community-dwelling older adults. Gerontology 58(3):197–204PubMedCrossRef Drey M, Zech A, Freiberger E, Bertsch T, Uter W, Sieber CC et al (2011) Effects of strength training versus power training on physical performance in prefrail community-dwelling older adults. Gerontology 58(3):197–204PubMedCrossRef
42.
Zurück zum Zitat Drey M, Pfeifer K, Sieber CC, Bauer JM (2011) The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology 57(1):11–18PubMedCrossRef Drey M, Pfeifer K, Sieber CC, Bauer JM (2011) The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology 57(1):11–18PubMedCrossRef
43.
Zurück zum Zitat Kemmler W, von Stengel S, Engelke K, Sieber C, Freiberger E (2016) Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOsA study. Osteoporos Int 27(1):275–281PubMedCrossRef Kemmler W, von Stengel S, Engelke K, Sieber C, Freiberger E (2016) Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOsA study. Osteoporos Int 27(1):275–281PubMedCrossRef
44.
Zurück zum Zitat Hawley-Hague H, Horne M, Skelton DA, Todd C (2016) Older adults’ uptake and adherence to exercise classes: instructors’ perspectives. J Aging Phys Act 24(1):119–128PubMedCrossRef Hawley-Hague H, Horne M, Skelton DA, Todd C (2016) Older adults’ uptake and adherence to exercise classes: instructors’ perspectives. J Aging Phys Act 24(1):119–128PubMedCrossRef
45.
Zurück zum Zitat Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381PubMedCrossRef Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381PubMedCrossRef
Metadaten
Titel
Frailty and exercise interventions
Evidence and barriers for exercise programs
verfasst von
PD Dr. E. Freiberger
W. Kemmler
M. Siegrist
C. Sieber
Publikationsdatum
01.10.2016
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 7/2016
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-016-1134-x

Weitere Artikel der Ausgabe 7/2016

Zeitschrift für Gerontologie und Geriatrie 7/2016 Zur Ausgabe