Physical Exercise for Healthy Older Adults and Those with Frailty: What Exercise Is Best and Is There a Difference? A Systematic Review and Meta‐Analyses

Abstract

Background and Purpose. Physical exercise (PE) is a well‐recognized means of ameliorating the burden of morbidity that is associated with aging. However, the specific components of exercise programs, and health outcomes that are of benefit, are less consistently agreed upon. Further, it is not evident if those who are not considered to be healthy benefit from the same exercise as those who are. In this systematic review, we collated evidence with the aim of determining if exercise needs to be tailored to suit the needs of those who are frail compared to those who are healthy. Methods. All English studies published after 1989 with a controlled design, investigating PE in adults 65 years and over were considered if the study design compared PE to a nonexercise control group. Health‐related outcomes included physical, cognitive, and psychological function. Studies that investigated cardiorespiratory disease and used designs like systematic review were excluded. Results and Discussion. Altogether, 57 studies were included of which 38 had data that were useable for meta‐analysis. In the healthy aged, a significant benefit of multicomponent exercises (p = 0.006, SMD = 1.40, CI = 0.41, 2.40) and tai chi (p = 0.01, MD = 0.51, CI = 0.12, 0.91) on physical function was revealed, while strength exercise benefitted cognitive function (p = 0.04, SMD = 0.86, CI = 0.03, 1.68). In frail older adults, there was a significant benefit of multicomponent exercises on physical function (p < 0.0001, SMD = −10.85, CI = 5.66, 16.04) and mental health (p = 0.0002, SMD = −0.39, CI=‐0.18, 0.59). Strength exercise had a significant benefit on activity of daily living (ADL) (p < 0.0003, SMD = 15.78, CI = 7.28, 24.28). Conclusion. The substantial disparity of research in the field of exercise in older adults renders synthesis of the evidence problematic. However, it appears that multicomponent exercise is the most suitable approach for both healthy and frail older adults although the benefit may be reflected in different health outcomes.