Systematic review
Effect of Exercise on Physical Function, Daily Living Activities, and Quality of Life in the Frail Older Adults: A Meta-Analysis

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Abstract

Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis.

Objectives

To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults.

Data Sources

Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases.

Study Selection

The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group.

Data Extraction

The characteristics and outcome measures of the included studies were identified independently by 2 investigators.

Data Synthesis

The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by .07m/s (95% CI .02–.11), increased their BBS score (WMD=1.69; 95% CI .56–2.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups.

Conclusions

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

Section snippets

Search Strategy and Identification of Trials

The studies included in the literature review were identified from 6 electronic databases, namely, PubMed, MEDLINE, EMBASE, Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library Register of Controlled Trials. Studies published between 2001 and June 2010 were included. We adopted in our search the operational definition of frailty by Fried,4 Rolfson,5 and Speechley6 and colleagues. The following keywords and Medical Subject Headings were used in the search: (frail older adults,

Results

The searches in the electronic databases were performed on June 1, 2010. We retrieved 146 trials, 15 of which were identified after evaluating titles, abstracts, and full texts. Two studies were excluded owing to overlapped participant groups.25, 26 Moreover, 5 trials were excluded, 2 for having incomplete data (1 without raw mean and SD27 and the other without total score of assessment28) and 3 for having PEDro scores lower than 4.29, 30, 31 A total of 8 trials were included in our

Discussion

The meta-analysis performed provided evidence of the effects of exercise on the physical function, the performance in ADLs, and the QOL of the frail older adults. Exercise demonstrated significant benefits of increased gait speed and BBS score and improved performance in ADLs in the frail older adults, and a positive trend was observed in the scores in the mental health component of QOL within 8 included trials.

A significant increase was observed in gait speed after the exercise-training

Conclusions

To summarize, the exercise intervention only slightly affected physical function, mainly by increasing gait speed and BBS score and improving performance in ADLs. Notably, the participants in these trials may be unrepresentative of the total frail older adults population because of those who would have benefited from exercise but were excluded in the trial because of age or other comorbidities that prevented them from exercising. Furthermore, this review does not make clear recommendations

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