| Setting | Cardiac rehabilitation facility | Geriatric nursing home | University indoor exercise facility | Two senior welfare centres |
| Design | RCT, parallel | RCT, parallel, four-armed | RCT, parallel | RCT, parallel, three-armed |
| Aims of the study | To evaluate the value of resistance training on measures of physical performance in older women with coronary heart disease | To evaluate the short-term effects of three different low-intensity exercise interventions on physical performance, muscle CSA and ADL. | To evaluate whether a multidimensional exercise training program can significantly reduce frailty in community-dwelling older men and women | To investigate if there are differences in the effects of an exercise intervention due to the applied intensity of supervision |
| Sample size (analyzed), n | IG: 19, CG: 14 | IG: 22, CG: 23 | IG: 66, CG: 49 | IGc: 32, CG: 17 |
| Female gender, n | Overall: 100% | IG: 68.1%, CG: 65.2% | IG: 52%, CG: 53% | IGc: 30/32 (92%), CG: 15/17 (88%) |
| Mean age (SD), years, range | IG: 73.2 (6.0), CG: 72.2 (5.7) | IG: 85.5 (4.7), 83.6 (5.6), 75–96 | IG: 83 (4), CG: 83 (4) | IG1: 80,0 (6,7), IG2: 80,8 (5,3), CG: 77,2 (6,5) (completers only) |
| Participant health status (functional limitation criteria) | Patients had CHD diagnosed for > 6 months, MOS SF > 36, physical function domain score < 85 | Residents in geriatric nursing home | Defined frailty criteria including: Objective test, reported ADL and IADL dependency | Difficulty in rising from a chair and unilateral knee extensor strength below 25 kgf. |
| Residential status | Community-dwelling | Geriatric nursing home | Community-dwelling | Apartments for elderly connected to welfare centres |
| Description, intensity, duration and total number of sessions | 8 RT exercises focusing on leg, arm, and shoulder. Progressive program updated monthly | Low intensity RT program targeted major knee extensor muscles. 40% 1RM, 16 weeks, 48 session | Progressive whole-body RT program in weightlifting machines. 65–100% 1RM, 12 weeks, 36 sessions | 9 thigh muscles exercises. Resistance provided by body weight and elastic bands. 4–8 RM (elastic band exercises) 10 weeks, 30 sessions |
| Control condition | Control patients met 3 times per week performing stretching, calisthenics, deep-breathing progressive-relaxation exercises, and light yoga | No intervention. Refrain from participation in exercise programs | Sham intervention: 9 flexibility exercises | No intervention. Maintain habitually active |
| Self-reported measure of ADL-disability/function | MOS SF-36, physical function domain | Barthel Index | Functional Status Questionnaire | The Groningen Activity Restriction Scale (ADL/IADL) |
| Drop-out from intervention, n | IG: 5 (21%), CG: 4 (22%) | IG: 4 (18%), CG: 4 (17%) | IG: 20 (30%), CG: 8 (16%) | IGc: 18 (36%), CG: 5 (23%) |
| Compliance, % (criteria) | Patients were required to attend at least 54/72 sessions (75%). 2 patients failed, and were recorded as dropouts | 78% (mean attendance at sessions) | 100% (attendance at sessions. Less than 100% attendance led to exclusion) | IG1: 79%, range: 57–100%, IG2: 72% range 20–93% (mean attendance at sessions) |
| Direction of the effect on self-reported disability/function | No effect | Positive effect | Positive effect | No effect |
| Adverse events | No adverse events | No adverse events | One: rotator cuff injury, and one: RT exacerbating shoulder problem | Not reported |
| Notes | | | RT is the second of three 3-months intervention phases. We consider 3- and 6-month time points as baseline and endpoint test respectively | Two eligible RT-intervention groups. Degree of supervision varied between groups |
| Data notes | Published and unpublished data | | | Data from the two intervention groups were collapsed in all analysis |
| Included in primary meta-analysis | Yes | Yes | Yes | Yes |
| First author, year, country | Buchner et al., 1997, USA [35] | Cadore et al., 2014, Spain [36] | Chandler et al., 1998, USA [16] | Chin A Paw, et al., 2006, the Netherlands [37] |
| Setting | Enrolees in a health maintenance organization | – | The home of the elderly | Long-term care facilities |
| Design | RCT, parallel, four-armed | RCT, parallel | RCT, parallel | RCT, parallel, four-armed |
| Aims of the study | To investigate the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health service’s use in older adults | To investigate the effects of multicomponent exc. Intervention on muscle power output, muscle mass, tissue attenuation, fall risk and functional outcomes | To determine whether strength gain is associated with improvement in physical performance and disability | To evaluate the effectiveness of three different training protocols on functional performance and self-rated disabilities of older adults living in long-term care facilities. |
| Sample size (analyzed), n | IG: 22, CG: 29 | IG: 11, CG: 13 | IG: 44, CG: 43 | IG: 40, CG: 31 |
| Female gender, n | IG: 52%, CG:50% | 17/24 (70%) (completers only) | Overall: 50% | IG:29/40 (73%), CG26/31 (84%) |
| Mean age (SD), years, range | IG: 74, CG: 75 No SD | IG: 93,4 (3,2), CG: 90,1 (1,1) | IG: 77,5 (7,1), CG 77,7 (7,8) | IG: 80,9 (5,7), CG: 81,2 (4,4) |
| Participant health status (functional limitation criteria) | Unable to do an 8-step tandem gait without errors, below the reference 50th percentile in KE strength | Frieds frailty criteria, institutionalized | Inability to descent stairs step by step without holding the railing | Living in long-term care facilities. The population is referred to by the authors as frail |
| Residential status | Community-dwelling | Institutionalized | Community-dwelling | Nursing home/residential care |
| Description, intensity, duration and total number of sessions | RT of the upper and lower body using Cybex Eagle weight machines. Including training at the ankle joint using adjustable weights | 3 RT-exercises. 2 for knee extensors + chest press in machines (20 min). Gait and balance exercises (10 min). 8–10 RM, 12 weeks, 24 sessions | Home-based low-moderate intensity RT-programme using elastic band. Exercises target lower extremity muscles with slow velocities of movement. 10 RM, 10 weeks, 30 sessions | Long term care facility-based. 5 RT-exercises using machines, free weights and ankle/wrist weights. 60–80% 1RM, 24 weeks, 48 sessions |
| Control condition | Instructed to maintain usual activity | No intervention. Routine care and activities | No intervention. Controls were offered RT after the end of the trial | Attention control. Educational program led by professional creative therapist. 45–60 min twice weekly. |
| Self-reported measure of ADL-disability/function | Sickness Impact Profile, body care and movement subscale | Barthel Index | MOS SF-36, physical function domain | Disability in 17 ADLs |
| Drop-out from intervention, n | IG: 5 (20%), CG: 1 (3%) | IG: 5 (31%), CG: 3 (19%) | Overall: 13 (13%) | IG: 21 (37%), CG: 23 (45%) |
| Compliance, % (criteria) | IG: 95% (mean attendance at sessions) | 90% (attendance at sessions. Attendance was defined as ≥90% of prescribed exercises completed) | Not reported | 76% (mean attendance at sessions) |
| Direction of the effect on self-reported disability/function | No effect | Positive effect | No effect | No effect |
| Adverse events | No adverse events | Not reported | Not reported | No adverse events reported. N = 8 dropped out because the program was too intensive |
| Notes | One intervention group was eligible for inclusion in the analysis | | | One intervention group was eligible for inclusion in the analysis |
| Data notes | Ceiling effects of the Sickness Impact Profile, body care and movement-subscale was reported | Published and unpublished data | Post data not available | |
| Included in primary meta-analysis | Yes | Yes | No | Yes |
| First author, year, country | Clemson et al, 2012, Australia [38] | Danilovich et al., 2016, USA [39] | Fahlman et al., 2007, USA [40] | Hewitt et al., 2018, Australia [41] |
| Setting | Residents in metropolitan Sydney, Australia | Home-based, Illinois | University facilities, Urban area | Long -term residential aged care facilities |
| Design | RCT, parallel, three-armed | RCT, parallel | RCT, parallel, three-armed | RCT, Cluster |
| Aims of the study | To determine if a lifestyle integrated approach to balance and strength training is effective in reduces the rate of falls in high risk people | To test the effect of an RT-program on the physical performance and self-rated health of older adults receiving home and community-based services | To determine whether RT or a combination of RT and aerobic training resulted in the most improvement in measures of functional ability in functionally limited elders | To test the effect of published best practice exercise in long-term aged care, and determine if combined balance and progressive RT is effective in reducing the rate of falls |
| Sample size (analyzed), n | IG: 79, CG: 80 | IG: 24, CG: 18 | IG: 39, CG: 33 | IG: 93, CG: 82 |
| Female gender, n | IG: 57/105 (54,3%), CG: 58/105 (55,2%) | Overall: 83% | Not reported | IG: 71 (62.8%), CG: 73 (68.2%) |
| Mean age (SD), years, range | IG: 84,03 (4,38), CG: 83,47 (3,81) | CG: 74,1, CG: 75,6 | IG: 74,6 (SE;1,0), CG: 76,5 (SE 1,4) | IG: 86, 65–100, CG: 86, 65–99 |
| Participant health status (functional limitation criteria) | Two or more falls or one injurious fall in the past 12 months | Homebound, receiving long-term ADL-assistance and home management | Score < 24 on the SF-36 PFD (reference score = 30) | High- or low-care requirements (daily assistance by nurse / some assistance but not complex care-needs) |
| Residential status | Community-dwelling | Community-dwelling, homebound | Community-dwelling | Long-term residential care |
| Description, intensity, duration and total number of sessions | Structured home-based programme. 7 exercises for balance + 6 exercises for lower limb strength 3 times a week, 1 year | Health care assistant and DVD-delivered, RT program with elastic bands | RT program consisting of 13 exercises using resistive bands. Low-moderate intensity, 16 weeks, 48 sessions | Moderate intensity progressive RT program consisting of 5 exercises combined with high-progressive level balance program. 25 weeks, 50 sessions |
| Control condition | Sham intervention: 12 gentle flexibility exercises | No intervention. Usual care | No intervention. They were instructed to maintain their current level of activity | No intervention. Usual care |
| Self-reported measure of ADL-disability/function | The National Health and Nutrition Examination Surveys independence measure for Activities of Daily Living (NHANES ADL) | Patient-Reported Outcomes Measurement Information System (PROMIS), physical summary score/ADL | MOS SF-36, physical function domain | MOS SF-36, physical function domain |
| Drop-out from intervention, n | IG: 22 (21%), CG: 16 (15%) | IG: 3 (13%) | Not reported | IG: 16 (14%), CG: 15 (14%) |
| Compliance, % (criteria) | IC: 35% (SD: 29), CG: 47% (SD: 34) (adherence to programmes) | Not reported | Not reported | 54% (SD: 14.3) attended at least 30 sessions (60% adherence). Median attendance: 35 sessions |
| Direction of the effect on self-reported disability/function | No effect | No effect | No effect | No effect |
| Adverse events | One Surgery for inguinal hernia due to groin strain | No adverse events | Not reported | No major events. N = 3 reported short-term musculoskeletal pain, n = 1 non-injurious fall |
| Notes | | RT-program based on Jette 1996 | One intervention group was eligible for inclusion in the analysis | 48.9% of participants had a diagnosis of mild to moderate cognitive impairment |
| Data notes | Pre and post results are presented for different subsamples | | Extraordinary small sizes of variability distorted the meta-analysis of SMDs | Pre and post results are presented for different subsamples |
| Included in primary meta-analysis | No | Yes | No | No |
| First author, year, country | Latham et al., 2003, New Zealand [42] | McMurdo and Johnstone, 1995, USA [43] | Mihalko and McAuley 1996, USA [44] | Sahin et al., 2018, Turkey [45] |
| Setting | Five urban hospitals in New Zealand/Australia | The home of elderly receding in sheltered housing | Nursing home or senior citizen facility | Not reported |
| Design | RCT, parallel, four-armed | RCT, parallel, three armed | RCT, parallel | RCT, parallel, three armed |
| Aims of the study | To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving physical health of frail older people after hospital discharge | To develop a low technology approach to home exercise provision for elderly people with restricted mobility | To examine the effects of upper body high-intensity strength training on muscular strength levels, ADLs, and subjective well-being in elderly males and females. | To evaluate changes in the functioning of frail older adults after undergoing RT 3 days a week for 8 weeks |
| Sample size (analyzed), n | IG: 112, CG: 110 | IG: 21, CG: 28 | IG: 29, CG: 29 | IGc: 32, CG: 16 |
| Female gender, n | IG: 55%, CG: 51% | IG: 19/21 (90%), CG: 25/28 (89%) | Overall: 83% | Not reported |
| Mean age (SD), years, range | IG: 80 (range: 79–81), CG: 78 (range: 77–80) | IG: 81,4 (3,4), CG:81,9 (4,7) | Overall: 82.67 (7.72) | IG1: 84.18 (6.85), IG2: 84.50 (4.81), CG: 85.37 (4.70) |
| Participant health status (functional limitation criteria) | Frail according to criteria (Winograd). Admitted to geriatric rehabilitation unit. | Limited mobility, dependence in ADL | 19 used a wheelchair, 13 used walking assistance | Frailty according to Fried criteria |
| Residential status | Not specified | Sheltered housing | Nursing home | Nursing home |
| Description, intensity, duration and total number of sessions | Home-based quadriceps resistance program using adjustable ankle cuff weights. 3 sets of 8 reps of knee extensions in a seated position. | Low technology, low cost home exercise program using elastic bands. Emphasis on safety and respect for pain. 6 months with training on daily basis. No data on intensity | Upper body RT program with one exercise for the following muscle-groups: pectorals, latissimus dorsi, deltoids, biceps, and triceps. Performed with dumbbells | 11 RT exercises for upper and lower body. 1 set of 6–10 reps at a slow speed (6–8 s/rep). IG1: 70% 1RM IG2: 40% 1RM. 8 weeks, 24 sessions |
| Control condition | Received frequency-matched telephone calls and home visits from physical therapist who inquired about patient’s recovery, gave general advice. | Frequency and duration matched health education program. Informal discussions on exercise, diet, sleep, meditation, stress foot care and safety | Upper body, no-stress exercise program: Breathing techniques; movement of the neck, shoulder, arms, hands, and torso; and mild stretching activities | Instructed to continue usual daily routines |
| Self-reported measure of ADL-disability/function | MOS SF-36, physical function domain | Barthel Index | Barthel Index, tailored | Barthel Index |
| Drop-out from intervention, n | IG: 8 (7%), CG: 13 (10%) | Overall: 20% | Not reported | IGc: 0, CG: 0 |
| Compliance, % (criteria) | 82% (mean attendance at sessions) | Not reported | Not reported | Not reported |
| Direction of the effect on self-reported disability/function | No effect | No effect | Positive effect | Positive effect |
| Adverse events | The exercise group had an increased risk of musculoskeletal injury and higher scores of fatigue. | No adverse events | Not reported | Not reported |
| Notes | | One intervention group was eligible for inclusion in the analysis | | Two eligible RT-intervention groups. Work load intensity varied between groups. |
| Data notes | Missing baseline data | | ANCOVA test applied to account for baseline imbalances | Data from the two intervention groups were collapsed in all analysis but the sub-analysis for training intensity |
| Included in primary meta-analysis | No | Yes | Yes | Yes |
| First author, year, country | Seyennes et al., 2004, France [17] | Timonen et al., 2006, Finland [46] | Venturelli et al., 2010, Italy [47] | Westhoff et al., 2000, the Netherlands [18] |
| Setting | Public nursing homes | Primary care health centre | Geriatric institute | Home-based/community centre-based |
| Design | RCT, parallel, three-armed | RCT, parallel | RCT, parallel | RCT, parallel |
| Aims of the study | To measure dose-response effect of a free weight-based RT program on KE muscle function, functional limitation and self-reported disability. | To determine the effects of a group-based exercise program on ADL and IADL activities relevant to daily life after discharge from hospital | To evaluate the feasibility of upper-body circuit-RT program, and to verify if arm training improves physical outcomes, ADL-function and cognitive outcomes. | To investigate if a 10-week low-intensity strength training program can improve strength of the knee extensors and functional ability in frail elderly. |
| Sample size (analyzed), n | IGc: 14, CG: 8 | IG: 26, CG: 30 | IG: 12, CG: 11 | IG: 10, CG: 11 |
| Female gender, n | Not reported | IG: 100%, CG: 100% | IG: 100%, CG: 100% | Not reported |
| Mean age (SD), years, range | IG1: 83.3 (2.8), IG2: 80.7 (2.3), CG: 80.3 (2.0) | IG: 83.5 (4.1) CG: 82.6 (3.7) | IG: 83,3 (6,7), CG: 84,1 (5,8) | IG: 75.9 (6.8), CG: 77.5 (8.1) |
| Participant health status (functional limitation criteria) | Institutionalized. Characterised by authors as frail. Objective measure not reported | Hospitalized due to an acute illness and mobility-impaired | Dependent in one or more ADL (BI), serious mobility limitation, MMSE > 15 < 25 | Difficulty in rising from a chair |
| Residential status | Public nursing home | Community-dwelling | Geriatric institute | Residents of assistant living facilities |
| Description, intensity, duration and total number of sessions | Classical progressive RT of the KE muscles using ankle cuffs. IG1: 80% 1RM, IG2: 40% 1RM, 10 weeks, 30 sessions | Group based progressive RT with weight training equipment plus functional exercises. 8–10 RM, 10 weeks, 20 sessions | Group based upper body RT program using dumbbells, looped, elastic bands, sticks and sponge balls. Progression by raising number of repetitions and or load | Individually tailored RT program for the KE using bodyweight and elastic band to provide resistance. 9 exercises. 4 RM (elastic band exercises), 10 weeks, 30 sessions |
| Control condition | Placebo: similar program with empty ankle cuffs | Instructions for a home exercise training program, including functional exercises. No further encouragement to exercise. | Kept their habits unaltered throughout the study. Were provided physiotherapy as usual | No intervention. Asked to continue with their normal activities |
| Self-reported measure of ADL-disability/function | Health Assessment Questionnaire | Tailored ADL/IADL function scale | Barthel Index | The Groningen Activity Restriction Scale (ADL/IADL), lower extremity-specific domain |
| Drop-out from intervention, n | Overall: 5 (19%) | IG: 8 (23%), CG: 4 (12%) | IG: 3 (20%), CG: 4 (27%) | IG: 4 (29%), CG: 1 (8%) |
| Compliance, % (criteria) | 99% (criteria not stated) | 90%, range 55–100% (mean attendance at sessions) | 75% (SD: 16%) (mean attendance to sessions) | 87% (mean attendance to sessions) |
| Direction of the effect on self-reported disability/function | No effect | No effect | Positive effect | Positive effect |
| Adverse events | No adverse events | Not reported | No adverse events | No adverse events |
| Notes | Two eligible RT-intervention groups. Work load intensity varied between groups. 5 drop outs in total. Number of dropouts on group-level is not reported. | ADL/IADL measured by proxy (health care personnel) | Very frail subjects - many are wheelchair users | |
| Data notes | Published and unpublished data. Data from two intervention groups were collapsed in all analysis but the sub-analysis for training intensity | Data not suitable for meta-analysis | | |
| Included in primary meta-analysis | Yes | No | Yes | Yes |
